Feline Diabetes

 

Feline Diabetes

Definition
Diabetes mellitus is an endocrine disease in which the blood sugar level rises because of the failure of insulin to control it. This occurs either because the pancreas has lost its ability to manufacture insulin (known as Type I diabetes) or because the mechanisms of insulin release and tissue responsiveness are dysfunctional (Type II diabetes). Without proper insulin regulation, the body is unable to transport glucose (a simple sugar obtained from digested food) into cells. Because glucose remains trapped in the bloodstream, the tissues of the body are deprived of the energy needed to function normally.

Risk factors
In many cases, the cause for why a cat has developed diabetes cannot be determined. However, it is known that obesity predisposes cats to Type II diabetes. Other causes or factors include damage to the pancreas caused by inflammation, infection, immune-mediated disease, tumors, genetic predisposition, and exposure to certain drugs. Cats receiving steroids are also predisposed to diabetes.

Symptoms
The most common symptoms of diabetes are weight loss (often with a healthy appetite), excessive water consumption, and excessive urine output. Because so much urine is being produced, some diabetic cats will urinate in unusual places (i.e., outside of the litter box). Owners may notice that litter has suddenly begun to stick to their cat’s paws because of the excess volume of urine being produced. Some cats will also show weakness, lethargy, vomiting, abnormal gait, poor grooming habits, and changes in behavior.

Diagnosis
Physical examination may show poor body condition, dehydration, jaundice, and an enlarged liver. Laboratory testing is essential to diagnose diabetes. Blood tests show hyperglycemia (high blood sugar, usually above 300 mg/dl), and often there are liver enzyme abnormalities. In complicated cases, there may be electrolyte imbalances and acidosis (acidic blood). Urine samples will show high levels of glucose and in some instances, infection.

Blood and urine tests are required for several reasons: 

  1. The common symptoms of diabetes are similar to those of other diseases, especially kidney disease, hyperthyroidism, and cancer
  2. To detect other illnesses that may complicate the management of diabetes and
  3. The severity of diabetes will determine initial treatment options and prognosis.

Treatment
Successful management of the diabetic cat is a challenge for both owners and veterinarians. Recommendations regarding the treatment of feline diabetes are constantly evolving, and there is no standard protocol by which all cats can be treated. Treatment requires a time and financial commitment on your part: your cat will require daily medication and feeding at consistent times, there will be frequent visits to our office, and you will need to monitor changes in your cat’s behavior to help guide us in the management of the disease.

Modes of treatment

Insulin injections — Insulin is the cornerstone of the treatment of most diabetic cats. Although your cat may not be placed on insulin injections (shots) immediately, many diabetic cats will eventually require insulin to successfully manage their condition. Currently, insulin can only be given by injection. There are two commonly used forms of insulin, Glargine (Lantus™) and protamine-zinc (Pro-Zinc™) insulin.

Glargine insulin — Is long-acting insulin commonly used in human diabetics. Although it is not approved specifically for use in cats, it is often used in newly diagnosed diabetics because it is the insulin that is most likely to cause cats to convert back to the non-diabetic state (go into remission). Given this fact, frequent blood sugar checks either by the owner at home or at the veterinary office are recommended.

Pro-zinc insulin — Is a long-acting human recombinant insulin approved for use in cats. This insulin is dilute insulin and dosed using a special type of insulin syringe. The syringes and insulin are only available through veterinarians.

Dietary therapy — Because cats are obligate carnivores, they require a diet high in protein and low in carbohydrates.  Canned foods most closely resemble the natural diet of cats and also help to increase fluid intake. We often use these diets for weight loss in diabetic and non-diabetic cats. In some instances, cats on canned-only diets will reverse their need for insulin therapy.

Some cats will overeat when allowed constant access to food, which may worsen the diabetic condition. If your cat eats all the food that is offered at mealtimes, feed the cat twice a day in conjunction with the insulin administration. If your cat refuses to eat canned foods, we can discuss ways to train them to accept them or you can try the high protein dry diabetic diets.

*Please note* If your cat will not eat food and insulin is given, low blood sugar (hypoglycemia) may result and can be a life-threatening emergency. Please do not try to force your cat to eat a certain diet.

Monitoring
Cats that are being managed with only diet modification are usually checked within 2-4 weeks. An examination and blood glucose measurement will evaluate whether the diet alone is effective. When to next perform re-check exams and blood glucose measurements will be determined at that time.

Cats that are placed on insulin typically have an examination and blood sugar determination made after a week or two of therapy. The dose of insulin may then be adjusted depending on the cat’s response. At that time, we will also determine when a recheck examination and blood sugar measurement should next be made.

Some owners may be interested in taking blood glucose measurements from their cats at home. These measurements may be a better reflection of the cat’s true blood sugar, as visits to the veterinary hospital can sometimes induce stress hyperglycemia (elevated blood sugar due to stress).  These measurements would then be shared with your veterinarian to determine insulin response. Owners that are not comfortable with at-home monitoring can choose to bring the cat to the veterinary hospital, as directed by the veterinarian.

Complete blood work and urinalysis should be conducted to monitor for changes in liver values, monitor for infection, and check general health status semi-annually or as recommended by your veterinarian. Your veterinarian may also recommend checking a fructosamine level. Blood fructosamine is a measure of glucose bound to proteins in the blood and reflects the average blood sugar over the past 1-3 weeks.

Complications of Diabetes

In general, diabetic cats suffer fewer secondary problems than humans or dogs. They do not develop kidney failure, skin infections, or circulation problems.  Most complications occur because of inadequate control of the disease and may include:

  1. Peripheral neuropathy (a condition affecting the nerves to the legs, head, and tail) — This is a relatively common problem that initially appears as weakness in the hind legs. The cat generally walks so that its hock (the ankle joint) is touching the ground rather than just its toes. The owner may notice difficulty jumping or using the litter box properly. The nerves in the front legs may also be affected so that the carpus (the wrist joint) sinks toward the ground as well.  As the condition progresses, nerves in the head, neck, and tail may also be affected causing a generalized weakness.  Neurologists believe this condition does result in some discomfort, especially in the extremities (lower legs and paws). Cats with well-regulated diabetes are less likely to develop this condition, and cats that have developed the condition may improve once the diabetes is controlled.
  2. Ketoacidosis — This is a potentially fatal condition that develops when diabetes is uncontrolled or untreated. When the body is deprived of sugar as an energy source, it begins to break down fat stores for energy instead. The by-products of fat metabolism include ketones, which are acids that have toxic effects on the brain and other tissues. These cats are quite sick and symptoms include severe lethargy, poor appetite, vomiting, abdominal pain, and coma. The electrolyte imbalances and dehydration that can occur with this condition are often severe and potentially life-threatening requiring hospitalization and intensive treatment.
  3. Hypoglycemia (low blood sugar) — This is almost always associated with an overdose of insulin, but may also occur if the insulin requirements of the cat change. See the section on giving insulin injections for information on how to spot and avoid hypoglycemia.
  4. Urinary Tract Infections — Diabetic cats lose glucose in their urine. The sugar provides energy for bacteria to colonize the bladder.
  5. Hepatic lipidosis (fatty liver disease) — This potentially treatable disease occurs when the liver begins to mobilize fats to use as energy due to either decreased appetite or increased need for utilizable energy. The excess accumulation of these fats within the liver leads to liver failure. Symptoms may include lethargy, poor appetite, vomiting, and jaundice. Treatment often requires hospitalization for fluid therapy, correction of electrolyte imbalances, and supplemental feeding, which may include placement of a feeding tube.
  6. Pancreatitis and pancreatic digestive enzyme deficiency — Although not a consequence of diabetes, this condition often is present in diabetic cats. Chronic inflammation of the pancreas can lead to scarring and degeneration of pancreatic tissue. The pancreas is responsible for the production of digestive enzymes as well as insulin. When a cat becomes deficient in digestive enzymes, exocrine pancreatic insufficiency (EPI) may occur. Symptoms include diarrhea, frequent or large bowel movements, pale-colored stool, weight loss, and vomiting. Treatment consists of adding pancreatic enzymes to meals.

Prognosis
We are often asked how long a cat will live if it has become diabetic. Because of the extreme variability among diabetic cats, this question is difficult to answer.  In general, our impression is that diabetic cats have a shorter life span than average. However, many cats can live for years following diagnosis if appropriate therapy is given. Also, there is a small percentage of cats that can go into diabetic remission either temporarily or sometimes permanently if treatment is initiated early in the disease.

Insulin Therapy

This guide will help you understand how to give injections, how to store and handle insulin, and problems that may occur while your cat is on insulin therapy. We want to make you as comfortable as possible with the treatment and will address all of your questions and concerns.

Demonstration of insulin injections
We will schedule a time for one of our veterinary technicians to show you how to give injections. Information provided during this session (which lasts 10-20 minutes) will include how to measure the dose of insulin, where and how to give the injection, and how to store and handle insulin.

Timing of the insulin injections
You will be giving insulin either once or twice a day (most cats will need morning and evening doses). If your cat has been prescribed injections only once a day, it is best to give it when the cat eats the most. For most people, this is in the morning when fresh food is put down. If you have been instructed to give injections twice a day, the injections should be as close to 12 hours apart as possible, and no sooner than 10 hours apart unless your veterinarian has instructed otherwise. If you cannot give a dose or miss a dose, it is better to skip that dose than to try to double up on injections. Return to regular dosing at the next scheduled injection.

Where to buy insulin and insulin syringes

  • Glargine insulin (100 units of insulin per ml, U-100): You will need a prescription for this insulin and may get it at any human pharmacy. The U-100 (orange capped) insulin syringes may be purchased from a veterinary hospital or any pharmacy.
  • Pro-Zinc insulin (40 units of insulin per ml, U-40): You will need to buy the insulin and special U-40 (red-capped) syringes from a veterinary hospital only.

Storage and care of insulin
Insulin should be kept in the box, in refrigeration. Prolonged exposure to direct light (especially sunlight) or excessive heat will inactivate the insulin.  A few hours at room temperature in room light (e.g., being left on the kitchen counter) is unlikely to change the insulin activity. For Pro-Zinc, the insulin bottle should be gently rolled and inverted several times before it is given to the cat.  It should never be vigorously shaken or it may become less effective. Failure to gently mix the insulin before giving could result in over or under-dosing. Pro-Zinc insulin may be stored for 4 months with refrigeration. Glargine insulin does not need to be mixed and the insulin may be stored in the refrigerator for 6 months. If insulin is left at room temperature for greater than 12 hours, the bottle will only be good for 1 month.

Disposal of insulin syringes
Because of public health concerns, used insulin syringes should not be thrown away in your regular garbage. A hazardous waste container will be provided from our hospital during the insulin administration demonstration. When full, you may bring it in and we will dispose of the container properly and purchase a new one.

Monitoring Recommendations for Cats on Insulin
Initially, your cat will need to be monitored frequently as the dose of insulin is adjusted. If you choose, we can train you on how to take blood sugar measurements at home. This may reduce the amount of stress placed on your cat. The measurements would then be shared with your veterinarian and the dosage and timing of the insulin may be adjusted. If measurements are not made at home, you will be required to bring your cat in periodically (recommended times to be outlined by your veterinarian) for examination and blood sugar measurement. We do not generally recommend serial blood glucose monitoring in our feline patients, as the stresses of hospitalization may affect your cat’s appetite and may also falsely elevate blood sugar levels. However, in some cases, we may suggest a serial blood glucose test to determine the correct dose of insulin needed or to assess response to current insulin therapy. We strongly recommend a physical examination and full blood work and urinalysis every 6-12 months.

Websites for Information on Diabetes Mellitus

Frequent, Small Meals Promote Feline Weight Maintenance


I often talk to owners about the benefits of feeding cats multiple small meals throughout the day, an arrangement that most closely mirrors what nature intended and can help prevent diseases like obesity and diabetes mellitus. This is easier said than done, however. Most of us are busy enough that playing waiter to our cats every few hours is not practical. Here are a few tips for making frequent, small feline meals convenient for everyone involved.

Consider purchasing a timed feeder. Get one that allows you to schedule multiple meals throughout the day. Divvy up your cat’s total daily ration between each of the sections and let her rip. This option works really well for single cat households or when multiple cats have defined spaces where they go to eat. Feeders like these are also a godsend for the owners of cats who tend to want to eat in the wee hours of the morning.

Another option is to free feed, but place food bowls in an out of the way part of the home, ideally in an area that forces cats to climb stairs or otherwise exercise when travelling to and from their meals. When you think about it, this type of set up imitates a cat having to hunt for her food. She gets hungry, chases down a mouse (or climbs the stairs to her bowl), eats, and then finds a safe place to rest and digest until her next meal. This option works best for cats that are not gluttons and want to spend their free time someplace other than where their food bowl is located.

This is how I’ve fed most of my cats and it has worked well in all but one case. My cat Keelor was food motivated and not very active. He was perfectly happy to eat and then saunter just a few steps away and rest, even if it meant hanging out in the basement by himself. As a result he was a few pounds overweight his whole life. All of my other cats preferred to climb the stairs after meals to be with the rest of the family or sleep in a sunny spot on the couch. They maintained their weights within appropriate ranges despite being free fed.

If your home doesn’t allow you to place food in an out of the way location and a timed feeder isn’t an option, figure out another way to feed small amounts frequently and promote exercise in your cats. Offer at least three meals per day (before work, after work, and before bed). Four to six meals are even better. Make use of a cat’s natural hunting instincts by encouraging her to play with a kitty fishing pole, laser pointer, or other chase and pounce type toy.

The time you spend feeding small, frequent meals and promoting exercise for your cats will be rewarded with better feline health and fewer trips to the veterinary clinic.

Dr. Jennifer Coates

WRITTEN BY
Jennifer Coates, DVM
Veterinarian
Dr. Jennifer Coates is an accomplished veterinarian, writer, editor, and consultant with years of experience in the fields of veterinary...
Published Aug. 9, 2013

How to Identify Worms in a Cat

source: https://www.wikihow.com/Identify-Worms-in-a-Cat


Intestinal parasites, or worms, commonly occur in kittens and cats. These nasty pests are acquired in a number of ways. Kittens can pick up worm eggs via their mother's milk, young cats may get hookworm infections via their skin, and tapeworms are caught by ingesting fleas, infected rodents and rabbits. Because worms are so prevalent in cats, it is important to be able to recognize the signs that your cat has worms so that you can get it the treatment it needs as soon as possible.

Method1

Looking for Physical Signs That a Cat has Worms

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  1. Step 1 Take note if your cat develops a potbelly.
     A cat with a heavy worm burden (which means that they have a lot of worms), tends to have a potbelly but little fat cover over the spine or pelvis. A typical potbelly looks like a swollen tummy, round and full, and often the swelling is carried down low on the cat's body (the cat may even look pregnant).[1] The difference between a potbelly and a fat cat is the rest of the cat’s body is also in poor condition.
    • Roundworms are the most common cause of a potbelly, though other worms can also cause this symptom.
  2. Step 2 Check your cat’s body for fat pads.
     When you run your fingers over a healthy cat’s backbone, you will most likely be able to feel bumps along the spine, but should not be able to feel sharp, angular bones. This is because there is a fat padding over the cat’s bones. Cats that have a lot of worms will not have these fat pads. When you stroke the cat’s back and pelvis, you may find that you can feel each sharp, angular bone.
    • Body "condition" is a matter of assessing the fat cover over the cat’s bones. Landmarks such as the spine, hips, and pelvis are especially useful for this.
  3. Step 3 Look at the condition of your cat’s coat.
     Intestinal parasites steal much of the nutrition out of the cat's diet. This means that your cat does not get the vitamins, minerals, and proteins that they need to maintain a healthy coat. Check your cat for:
    • A dull coat.
    • A coat that lacks any sort of gloss.
    • A matted coat.
  4. Step 4 Pay attention if your cat experiences vomiting or diarrhea.
     Worms can physically irritate the stomach and intestinal lining, causing diarrhea and vomiting. A very high worm burden can physically obstruct the bowel and cause profound vomiting that is potentially life threatening. Cats can even vomit up a bundle of worms which look like squirming spaghetti.[2]
    • If your cat begins vomiting uncontrollably, bring him or her to the veterinary clinic immediately.
  5. Step 5 Look at your cat’s gum color.
     Some worms, especially hookworms, can make your cat’s gut bleed, which can result in slow but steady blood loss. This blood loss can lead to anemia, making your cat sluggish and weak if it is severe enough. In kittens it can be deadly.[3]
    • You can recognize anemia by lifting you cat’s lip and looking at her gums. If your cat’s gums are healthy, they should be pink in color. If the cat is anemic, the gums will be white, grey, or a washed-out pink.
  6. Step 6 Pay attention to signs of worms in kittens.
     Kittens with worm infections tend to be lethargic and fail to thrive. This means that they do not grow as well as their other litter mates. They are smaller, less vigorous, have dull coats, potbellies, and less fat over their ribs and backbone.
    • If you do not have other kittens for comparison, this can be difficult to assess but a fit, healthy kitten should be bright, playful, plump, and should have a soft, glossy coat.
    • Heavy worm burdens in a kitten can have life-long ramifications causing ill health throughout its life.
  7. Step 7 Check your cat for fleas.
     This is relevant because fleas carry tapeworm eggs. When a cat grooms itself, it may eat fleas infesting its coat, which allows the tapeworm eggs to enter into the cat's system.
    • It may be easier to look for flea dirt, rather than the fleas themselves. Flea dirt is dried blood excreted by the flea and is often present in the coat of infested animals.
    • To look for flea dirt brush a section of the coat in the wrong direction and look for small dark dots near the base of your cat's hairs.
    • To check that the specks you find are flea dirt rather than just dust or dander, take a damp piece of white tissue and place the dirt on it. Because flea dirt is dried blood, when it comes into contact with the moisture the dirt will leave a red or orange stain.
    • If you find fleas or flea dirt you need to treat the cat for the fleas and the environment (ie the house and bedding material) to rid the cat and home of fleas.
Method2

Identifying the Type of Worm

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  1. Step 1 Understand why you should try to identify the worms.
     If you suspect your cat has worms, the next step is to try to identify the type of worm. This helps you to know what sort of medication is going to be effective in getting rid of the infestation.
  2. Step 2 Look for migrating tapeworm egg packs.
     Look under your cat's tail. Tapeworm egg packets migrate out of the cat's anus and get stuck around the fur near the rectum. The egg packets are a creamy-white color and are variously described as looking like rice grains, cucumber pips, or sesame seeds.[4]
    • The egg packets may also get stuck to the cat's bedding, so have a quick look at your cat’s bedding as well.
    • If you find these, take your cat to its veterinarian to get treated for tapeworm.
  3. Step 3 Check your cat's feces for tapeworms.
     This is much easier to do if your cat uses a litter tray. Examine the feces for the presence of worms. Sometimes these are visible on the surface of the stool, but more likely you will need to put on plastic gloves and use a disposable tool to break the pellet open and look for worms inside.
    • Tapeworms are a creamy white color, flat, and segmented. They average around 4 to 28 inches in length.[5] [6]
    • Dipylidium caninum: The cat can get this type of tapeworm by eating fleas infected with tapeworm eggs.[7]
    • Taenia taeniaeformis: Cats can get this type of tapeworm when they hunt, catch and eat rodents infected with this kind of tapeworm.[8]
  4. Step 4 Recognize roundworms.
     Roundworms are very common and look like spaghetti or noodles. On average they are two to four inches long, but can grow up to five inches in length.[9] There are two different kinds of roundworms, both of which can be picked up in different ways:
    • Toxocara cati: These worms can be picked up via the mother's milk, and most kittens are infected at birth. These are commonly responsible for pot-bellied kittens, and cause vomiting and diarrhea.
    • Toxascaris leonine: These roundworms are acquired from contact with infected cat or rodent feces. The worm is sometimes vomited up whole, or passed out in the stool.
  5. Step 5 Identify hookworms.
     Hookworms are small (0.5 to 1 centimeter), curly worms that have a hook-like mouth. They are very hard to see with the naked eye. Ancylostoma duodenalis can be found in a mother cat’s milk, though kittens can also be infected by this kind of worm by walking on soiled, infected bedding.
    • The tooth-like mouth parts attach to the lining of the small intestine and release an anticoagulant that causes blood seepage into the gut. Infected kittens tend to be anemic, lacking in energy, and grow poorly.
  6. Step 6 Ask your vet to check your cat for heartworms.
     Heartworms are much more common in dogs than in cats. That said, it is still possible for cats to become infected. This sort of worm is found in blood vessels rather than in the intestine, which means that you will have to get a vet to check your cat for these types of worms.
    • Dirofilaria immitis: Infected mosquitoes can transfer dirofilaria eggs into your cat’s bloodstream. The signs are nonspecific such as lack of energy, weight loss, and a cough. Sadly, some cats show no symptoms and die suddenly, because of a blockage in a main blood vessel to the heart.
  7. Step 7 Have your vet take a fecal sample for analysis.
     The best way to check for worms (excluding heartworms) before they become a huge health liability is to take a fresh fecal (stool) sample to your veterinarian’s office. Adult worm will lay eggs while living in the cat’s intestinal tract. These eggs will frequently (but not always) be passed in the stool and can be seen after special preparation and examination under a microscope.[10]
    • The eggs of different worms have a different physical appearance which aids in their identification.
    • If the examination of your cat and its feces proves fruitless, this does not mean that your cat does not have worms. It merely means that no worms were passed out of its body. Some cats can harbor large amounts of worms and not pass any out. The only way to be certain is to collect a fecal sample to take to your vet for analysis.[11]
    EXPERT TIP
    Brian Bourquin, DVM
    Brian Bourquin, DVM
    Cat Veterinarian

    Our Expert Agrees: Getting your cat's feces tested twice a year is the best way to regularly check for worms. This is especially important if your cats spend most of their time outdoors, though indoor cats are also at risk for worms.

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