Diabetes in Cats: Treatment Options, Challenges, and when Euthanasia might be the kindest decision
Diabetes is a chronic condition where a cat’s body cannot regulate blood sugar either due to inadequate insulin production, insulin resistance, or both. Diabetes can be a challenging disease to manage and can lead to life-threatening complications such as diabetic ketoacidosis or severe hypoglycemia (low blood sugar).
Some cats with diabetes do great. They get their insulin twice a day for years, never complain, and experience no complications. But some cats can be challenging to manage for a number of reasons.
Some cats, despite the best management, end up hospitalized over and over with complications, leading to a poor quality of life for the cat.
Other cats simply hate getting their injections, and put up a fight twice a day, every day, leading to a fraught relationship with the pet parent.
Sometimes our own lives get in the way: not all of us are easily able to be home twice a day to give our cat injections. Diabetic management can also become extremely expensive and even cost prohibitive for some families. There is nothing to be ashamed of if you feel this way.
As a hospice and palliative care doctor, my goal is always this: regardless of the path you choose, the most important thing is to make sure your cat’s time here on this Earth is full of love and happiness.
If you are one of the unfortunate pet parents whose cat’s diabetes has become so challenging to manage that you are considering euthanasia, schedule a teleconsult with one of our compassionate doctors. We will do everything we can to help you reach the best decision for you and your family.
Treatment of Diabetes in Cats
The mainstay of treatment for diabetes in cats is insulin therapy. Some cats can do well on dietary management alone. Most cats do best with insulin and dietary management. The right plan is different for each cat.
Insulin therapy for diabetic cats
Insulin injections are the cornerstone of treatment for most diabetic cats. With proper regulation, many cats can do well for many years. Insulin therapy involves giving your cat an injection of insulin twice a day. Your veterinarian will also monitor your cat’s blood sugar periodically to assess the dose of insulin and make sure it is appropriate. There are several new options for monitoring blood sugar (for example, the FreeStyle Libre) that can help you better regulate your cat’s blood sugar without tons of vet visits.
Pros of insulin therapy:
- Most cats with diabetes need insulin and will die without it. So for most diabetic cats, it is mandatory.
- If caught early, in combination with dietary management, some cats can achieve remission from their diabetes and get off insulin.
Challenges with insulin therapy:
- Requires twice daily injections and frequent blood glucose monitoring, which can be challenging for owners who live alone, have demanding jobs, or travel frequently. It can also be challenging in cats who are not tolerant of the injections.
- Insulin can be costly, as can be the ongoing monitoring required (since insulin itself can be a deadly drug, monitoring in this disease is NOT optional)
- Overdose of insulin can cause life-threatening hypoglycemia, seizures, and death
Dietary management for diabetic cats
A percentage of cats with diabetes, especially if caught very early, may go into remission with diet changes alone. Cats with diabetes benefit from a low-carbohydrate, high-protein diet. Canned pate diets are often the highest in protein and lowest in carbohydrates. I often recommend them OVER prescription diets for diabetes, which are often higher in carbohydrates.
Pros
- If your cat responds to dietary management and doesn’t need insulin, that is fantastic!
- Helps maintain a healthy body weight which keeps your cat healthier overall
- Non-invasive and relatively simple to implement
Cons
- Diet alone RARELY works, and we generally recommend starting with insulin AND dietary change to maximize the chance your cat achieves remission. If your cat goes into remission, diet can help your cat maintain remission.
- Some cats don’t like canned food as much if they are used to dry food.
Combination of insulin AND diet for diabetic cats
The fact is, most cats respond best to a combination of insulin therapy AND dietary management for diabetes. And if you are one of the lucky cat owners and your cat achieves remission you may be able to stop the insulin, but they should continue to eat a low-carbohydrate high-protein diet for the rest of their life.
Complicated diabetes: When Euthanasia might be on the table
As a former emergency veterinarian, I frequently saw cats come in with diabetic ketoacidosis (DKA), a life-threatening complication of diabetes that often requires prolonged hospitalization. Some of these cats, despite the best management and most diligent pet parents, would end up hospitalized every month or two because they kept experiencing ketoacidosis.
Repeated hospitalizations can become incredibly stressful for cats, who hate being in the hospital. They’re very stressful for pet parents too, who are constantly wondering whether or not their sweet cat might suddenly take a turn for the worse and need to be hospitalized for DKA. It can also quickly become financially prohibitive, as each hospitalization for DKA can sometimes reach upwards of $10,000.
Pet parents would say to me privately: I know their disease is not terminal, and I feel so guilty that I am thinking about euthanasia. I just can’t take it anymore.
For some pet parents, even the day to day management of diabetes is too much. Some cats hate their injections so much they fight their owner, clawing and scratching, then spend their days hiding in the closet out of fear of the injection. This is no way for a cat to live.
For other pet parents, human considerations make diabetic management difficult or impossible. Some people have to travel frequently for work, live alone, and do not have a trusted pet sitter who can safely give injections and monitor a diabetic cat, for example. There are also cats who hate going to the vet so much it is unfair to put them through the sorts of medical care diabetes often requires. And there are some people for whom the cost of the medications and monitoring is just too much. If you fall into any of these categories, you’re not a bad person for considering euthanasia.
There is nothing to feel guilty about. All our cats want from us is our love. Cats do not think about how long they live. They live in the moment. The only thing that matters is do they feel happy and safe. The only wrong decision would be to do nothing and allow your cat to wither away and suffer from untreated diabetes.
If you find yourself considering euthanasia with your diabetic cat, below are some criteria that may indicate it is the kindest option:
- Repeated diabetic crises: multiple episodes of hypoglycemia or ketoacidosis
- Severe weight loss and muscle wasting despite treatment
- Inability to administer insulin or monitor your cat’s blood sugar
- Persistent nausea, vomiting, or lack of appetite
- Weakness or neuropathy that prevents walking, using the litter box, or grooming
- Signs of pain, distress, or confusion.
Our comprehensive quality of life scale (https://pawsatpeace.com/quality-of-life-scale/) can help you assess your cat’s quality of life. This quiz can be taken once to give you a snapshot of your cat’s quality of life, or taken multiple times to assess trends over time.
Conclusion
If you have found this page, I’m sorry for what you are going through. You are here because you love your cat.
If you are not sure what to do and would like more guidance and support, we offer comprehensive teleconsults with compassionate veterinarians. We will review all your cat’s medical records and history, discuss all your options, and help you formulate the most compassionate and loving plan for your family.