Emergencies first
The two things to recognize immediately
Learn these before you need them. Both can arrive at 2am.
Low blood sugar (hypoglycaemia)
The risk that comes with treatment, and the one that moves fastest. Most often after a dose given when the cat did not eat, a dose given twice, or a cat going into remission while still on the old dose.
Weak or wobbly, shaking, glassy-eyed or confused, then collapse or a seizure. Below 60 mg/dL (3.3 mmol/L) is an emergency: if your cat can eat, offer its usual food; if it is too weak to eat, rub a little corn syrup or honey on the gums with a finger and never pour liquid into the mouth. Give no insulin, and call the vet now.
Diabetic ketoacidosis (DKA)
Builds over hours to days when too little insulin is working, and it is life-threatening.
Vomiting, not eating, marked lethargy, fast breathing and a sweet or nail-polish smell on the breath. On the once-daily oral medicines (bexagliflozin, velagliflozin), DKA can happen with a normal glucose reading, so these signs mean call the vet now, whatever the meter says.
Source: AAHA Diabetes Management Guidelines 2018 · Merck Veterinary Manual · FDA product labels (bexagliflozin, velagliflozin)
In FelineSense
Every dose and every reading, kept for the vet
- Insulin or a once-daily oral medicine (bexagliflozin, velagliflozin), with the dose copied exactly as your vet wrote it. The app never calculates, suggests or changes a dose
- A did-your-cat-eat check before each dose, with given, reduced or skipped, and your vet’s instruction for a missed meal kept word for word
- Readings in mg/dL or mmol/L, each with a plain verdict against the feline targets
- Injection sites that rotate through the sides, flanks and hips, and an opened-vial countdown from the label
- The emergency signs one tap away, and a diabetes section in the vet report. See all three chronic conditions
Launching first on iPhone and iPad, with Android and Amazon soon after.
Day to day
What managing feline diabetes involves
The prescribed insulin or oral medicine at the same times each day, regular measured meals, glucose checks at home, and knowing the signs of low blood sugar.
Remission is possible in cats
Most diabetic cats have a form much like type 2 diabetes in people: the body still makes some insulin but responds to it poorly, and obesity is the biggest risk factor. Unlike dogs, many diabetic cats can go into remission and stop needing insulin. It is most likely when good control starts soon after diagnosis, alongside the low-carbohydrate, high-protein diet your vet recommends.
The catch: a cat heading into remission needs less insulin, and the old dose can push it too low. Falling numbers are a reason to call your vet about the dose, never to change it yourself.
Source: AAHA Diabetes Management Guidelines 2018 · Cornell Feline Health Center
The glucose numbers vets use for cats
In a diabetic cat, AAHA aims for glucose of roughly 80–300 mg/dL (4.4–16.7 mmol/L) through the day, with the lowest point, the nadir, ideally 80–150 mg/dL (4.4–8.3 mmol/L). A healthy cat runs about 70–150 mg/dL.
Stress raises a cat’s glucose: a healthy cat at the clinic can read 200–300 mg/dL. That is why readings taken calmly at home, and the fructosamine blood test, which reflects the past one to two weeks, matter so much. Use a pet glucose meter set to the cat code: human meters read low in cats.
Source: AAHA Diabetes Management Guidelines 2018 · Merck Veterinary Manual
Food first, then insulin
Insulin lowers blood sugar whether or not there is food to work on. So the order matters: confirm your cat ate, then give the dose. If your cat refuses a meal, follow the standing instruction your vet gave you for that situation, and call; never give the usual dose and hope. A cat that stops eating for more than a day also risks fatty liver disease (hepatic lipidosis). FelineSense asks whether your cat ate the meal before it logs an injection, and keeps your vet’s instruction word for word.
Source: AAHA Diabetes Management Guidelines 2018
The day curve, and why your vet keeps asking for it
A single reading could be the peak, the low point or anywhere between. A curve is a series of readings across one day, about every 2 hours for 12 hours, and its lowest point, the nadir, together with when it falls, tells your vet whether the dose and timing are right. From memory or scribbled notes it is nearly useless; plotted properly it is the most valuable thing you can bring to an appointment.
Source: AAHA Diabetes Management Guidelines 2018
Insulin, oral medicines and the open vial
Most diabetic cats are treated with a long-acting insulin such as glargine or protamine zinc insulin (PZI), given twice a day. Two once-daily oral medicines, bexagliflozin (Bexacat) and velagliflozin (Senvelgo), are FDA-approved for cats not previously treated with insulin.
An opened insulin vial or pen lasts a limited number of days, set by its label: for example 28 days for glargine, and 60 or 80 days for veterinary PZI depending on the vial size. Past that it loses strength quietly, which looks exactly like control drifting for no reason. Note the date you open it, handle it gently, store it as the label says, and never freeze it.
Source: AAHA 2018 · FDA product labels
Consistency beats precision
Same food, same amounts, same times, every day. Your cat’s dose was set against a routine, so changing the routine changes what the dose does. Write down the deviations too: the half-eaten meal, the treat, the stressful vet visit, the new food. Those are usually what explains an odd reading.
In the app
The curve your vet asks for
Spotting it
Signs of diabetes in cats
What owners notice first
- Drinking and peeing more: bigger or more clumps in the litter box, a bowl that empties faster.
- Weight loss with a good or bigger appetite.
- Walking flat on the back legs, with the hocks touching the ground, from nerve damage.
- Risk factors: obesity, inactivity, older age, male sex and long-term steroid treatment.
Drinking more is also a sign of kidney disease and an overactive thyroid, the other two common conditions of older cats. Only blood and urine tests can tell them apart. How much drinking is too much is in the water intake guide.
Source: Cornell Feline Health Center · Merck Veterinary Manual · AAHA 2018
Questions
Frequently asked
What are the first signs of diabetes in cats?
Can a diabetic cat go into remission?
What is a normal blood sugar for a cat?
What is a glucose curve and why does my vet want one?
Should I give insulin if my cat will not eat?
Why is my cat’s glucose so high at the vet?
Can I use a human glucose meter on my cat?
FelineSense keeps the dose exactly as your vet wrote it, every reading with its verdict, the day curve with its nadir and the vial date, in one record for the vet. It never calculates or changes a dose.
See the app