Diabetes Mellitus in Cats

The goals of dietary management are to:

• help regulate glycemic control to manage clinical signs of diabetes, including polyuria, polydipsia, polyphagia, and weight loss 
• achieve and/or maintain healthy body condition and muscle mass 

Key Messages

• Nutritional management of diabetic cats is different than for diabetic dogs because of the underlying disease etiologies. 
  • In newly diagnosed cats, the first goal of management is to gain glycemic control through diet and medication, including insulin as needed.
  • The most important complication associated with insulin therapy is excessively low blood glucose level. Signs of hypoglycemia may occur suddenly and can include: 
    • weakness
    • lethargy
    • restlessness
    • disorientation
    • incoordination
    • changes in behavior
    • muscle twitching
    • seizures
    • coma
• Nutritional recommendations include:^4,8 
  • A high-protein diet (defined as dietary protein ≥ 40% of metabolizable energy [ME] calories) is preferred for diabetic cats because it can help stabilize glucose levels, maximize metabolic rate, avoid protein malnutrition, prevent muscle mass loss, and improve satiety.⁷ 
  • Dietary carbohydrates should be restricted. A suggested target is ≤ 12% of ME calories or 3 grams (g) of carbohydrates/100 kilocalories (kcal).^4,9,10 
    • Studies suggest the amount and type of dietary carbohydrate strongly influence postprandial insulin and glucose concentrations in cats.⁴
    • Multiple studies support the efficacy of high-protein, low-carbohydrate diets to improve insulin sensitivity, decrease insulin needs, and enhance glycemic control.^9,11─14 
• Once glycemic control is established, managed weight loss in obese cats can help decrease insulin resistance, improve insulin control, and increase chances for diabetic remission.
  • Overweight or obese cats who are regulated, have stable body weight, and still need to lose weight may benefit from a high-protein (> 40% ME calories, > 10 g protein/100 kcal), lower-calorie diet fed at 80% of resting energy requirement for ideal weight.⁸ 
    • Target weight loss is 0.5% to 1% of body weight per week. Rapid weight loss should be avoided due to the risk for hepatic lipidosis and excessive loss of lean body mass.⁸
    • A high-protein, low-carbohydrate diet helps maintain insulin sensitivity, which can help increase fat loss and preserve lean body mass during weight loss.⁶ 
    • A higher-fiber, high-protein weight management diet may be useful in some obese, diabetic cats to facilitate weight loss. Digestible carbohydrates should be limited to 12% to 26% of ME calories in these diets.^4,8,15 
• Feeding ad libitum or multiple small meals each day may optimize glucose management. 
  • Research shows diabetic cats can be allowed to follow a typical feline food ingestion pattern of many small meals since they tend to have small changes in blood glucose and minimal postprandial hyperglycemia. Consequently, insulin injections do not need to coincide with meal feeding in diabetic cats that are naturally eating many small meals daily.¹⁶
  • Overweight or obese diabetic cats will still benefit from a portion-controlled amount of food as part of a weight loss program.
• Checking for clinical signs is important to effective diabetes monitoring. Useful, practical indicators of diabetes control in cats are water intake or urine output over a 24-hour period, as well as assessment of the cat’s activities, appetite, and demeanor.⁴ Other parameters owners can monitor at home include body weight and body condition.
  • Pet owners may want to buy a baby or small animal scale so they can monitor body weight at home. They can also learn how to perform body condition scoring at home.
  • Weight loss in obese patients often reduces the amount of insulin needed to maintain healthy blood glucose levels.
  • Rapid and/or unplanned weight loss is an indication of poorly controlled diabetes.
• Adjust dietary recommendations, as needed, when concurrent diseases are present (e.g., pancreatitis, renal disease, or intestinal disease).

1. Gottlieb, S., & Rand, J. (2018). Managing feline diabetes: Current perspectives. Veterinary Medicine: Research and Reports, 9, 33–42. doi: 10.2147/VMRR.S125619
2. Hoenig, M., Reusch, C., & Peterson, M. E. (2000). Beta cell and insulin antibodies in treated and untreated diabetic cats. Veterinary Immunology and Immunopathology, 77(1-2), 93–102. doi: 10.1016/s0165-2427(00)00229-4
3. Slingerland, L. I., Fazilova, V. V., Plantinga, E. A., Kooistra, H. S., & Beynen, A. C. (2009). Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus. The Veterinary Journal, 179(2), 247–253. doi: 10.1016/j.tvjl.2007.08.035
4. Sparkes, A. H., Cannon, M., Church, D., Fleeman, L., Harvey, A., Hoenig, M., Peterson, M. E., Reusch, C. E., Taylor, S., Rosenberg, D., & ISFM. (2015). ISFM consensus guidelines on the practical management of diabetes mellitus in cats. Journal of Feline Medicine and Surgery, 17(3), 235–250. doi: 10.1177/109812X15571880
5. Scarlett, J. M., & Donoghue, S. (1998). Associations between body condition and disease in cats. Journal of the American Veterinary Medical Association, 212(11), 1725–1731.
6. Hoenig, M., Thomaseth, K., Waldron, M., & Ferguson, D. C. (2007). Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss. American Journal of Physiology–Regulatory, Integrative and Comparative Physiology, 292(1), R227–R234. doi: 10.1152/ajpregu.00313.2006
7. Behrend, E., Holford, A., Lathan, P., Rucinsky, R., & Schulman, R. (2018). 2018 AAHA diabetes management guidelines for dogs and cats. Journal of the American Animal Hospital Association, 54(1), 1–21. doi: 10.5326/JAAHA-MS-6822
8. Clark, M., & Hoenig, M. (2021). Feline comorbidities: Pathophysiology and management of the obese diabetic cat. Journal of Feline Medicine and Surgery, 23(7), 639–648. doi: 10.1177/1098612X211021540
9. Bennett, N., Greco, D. S., Peterson, M. E., Kirk, C., Mathes, M., & Fettman, M. J. (2006). Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. Journal of Feline Medicine and Surgery, 8(2), 73–84. doi: 10.1016/j.jfms.2005.08.004
10. Zoran, D. L., & Rand, J. S. (2013). The role of diet in the prevention and management of feline diabetes. Veterinary Clinics of North America: Small Animal Practice, 43(2), 233–243. doi: 10.1016/j.cvsm.2012.11.004
11. Boari, A., Aste, G., Rocconi, F., Dalessandri, A., & Vita, S. (2008). Glargine insulin and high-protein-low-carbohydrate diet in cats with diabetes mellitus. Veterinary Research Communications, 32(Suppl 1), S243–S245. doi: 10.1007/s11259-008-9119-x
12. Frank, G., Anderson, W., Pazak, H., Hodgkins, E., Ballam, J., & Laflamme, D. P. (2001). Use of a high-protein diet in the management of feline diabetes mellitus. Veterinary Therapeutics, 2(3), 238–246.
13. Marshall, R. D., Rand, J. S., & Morton, J. M. (2009). Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins. Journal of Feline Medicine and Surgery, 11(8), 683–691. doi: 10.1016/j.jfms.2009.05.016
14. Mazzaferro, E. M., Greco, D. S., Turner, A. S., & Fettman, M. J. (2003). Treatment of feline diabetes mellitus using an alpha-glucosidase inhibitor and a low-carbohydrate diet. Journal of Feline Medicine and Surgery, 5(3), 183–189. doi: 10.1016/S1098-612X(03)00006-8
15. Laflamme, D. P. (2020). Understanding the nutritional needs of healthy cats and those with diet-sensitive conditions. Veterinary Clinics of North America: Small Animal Practice, 50(5), 905–924. doi: 10.1016/j.cvsm.2020.05.001
16. Martin, G. J. W., & Rand, J. S. (1999). Food intake and blood glucose in normal and diabetic cats fed ad libitum. Journal of Feline Medicine and Surgery, 1(4), 241–251. doi: 10.1053/jfms.1999.0052