To grasp diabetic remission in cats, it helps to have an understanding of feline diabetes, so here is a quick review.
What is feline diabetes?
Diabetes is a complex disease involving a hormone called insulin. When a cat does not make enough insulin or cannot properly use the insulin it does make, diabetes results. Why is insulin important? Insulin keeps the body’s engine working properly.
The body is like a well-tuned machine and needs fuel to run properly. The fuel for a cat is food that contains fats, carbohydrates, and proteins. But this fuel needs to be broken down into smaller parts that the body can utilize. One of these usable fuel components is glucose. Without glucose, the body’s engine stalls.
Glucose must enter the body’s individual cells to keep the engine running. That is where insulin comes in to play. Insulin regulates the flow of glucose from the blood stream into the cells where it is needed to sustain life.
When there is not enough insulin produced by the pancreas, or the cat does not use it effectively, glucose cannot enter the cells and high levels of glucose build up in the bloodstream. This condition is called diabetes.
What are the signs of diabetes?
"The common signs of diabetes include increases in appetite, water consumption, and urination, along with weight loss."
Without insulin to steer glucose into the cells, the cat's body looks for alternative sources of fuel and breaks down reserves of fat and protein stored in the body. Fueling the body is not efficient without the insulin/glucose team, so the cat loses weight despite eating more.
Meanwhile, the accumulation of glucose in the blood stream is eliminated in the urine. The cat urinates more which makes him thirsty and he drinks more water. The common signs of diabetes include increases in appetite, water consumption, and urination, along with weight loss.
If untreated, diabetes results in vomiting, dehydration, lethargy, coma, vision loss, and even death.
How are cats with diabetes treated?
Cats with diabetes need constant attention. They eat a special low carbohydrate diet to reduce the amount of glucose in the body. Even so, most cats require insulin injections twice daily to keep blood glucose in check. The injections are administered under the skin in rotating sites, preferably at the same time each day.
In addition to extensive home care, diabetic cats need frequent visits to the veterinary hospital for blood monitoring, urine tests, and physical exams. Considering the effort it takes to care for a cat with diabetes, remission, even short term, is a welcome relief for both cat and cat owner.
What is diabetic remission?
"Diabetic remission occurs when a cat maintains a normal glucose level for more than four weeks without insulin injections or oral glucose regulating medications."
The primary goal of treating diabetes is to regulate blood glucose quickly and reach a point where the cat no longer needs insulin therapy. Diabetic remission occurs when a cat maintains a normal glucose level for more than four weeks without insulin injections or oral glucose regulating medications.
Not all cats go into remission, but those that do may stay that way for months or years. One estimate states that 17 to 67% of cats experience remission after insulin therapy. Other estimates predict remission is possible in 90% of cats.
The key factors in achieving remission are quick institution of insulin therapy post-diagnosis and strict adherence to a low carbohydrate diet. Frequent monitoring with appropriate adjustments of insulin dosage increases the odds of remission.
What other factors impact remission?
- Diet type
Since canned food has fewer carbohydrates than dry food, moist diets are recommended, but low carbohydrate content is not the only dietary requirement of diabetic cats. There is a higher chance of remission if the food also has low fiber content. Many diabetic cats suffer from renal disease, so having a low phosphorus level in the diet is also important. Proper diet can result in better blood glucose control and reduce the amount of daily insulin needed.
- Insulin and other glucose regulators
The goal is to lower blood glucose levels without going too low (hypoglycemia). Calculated insulin doses paired with a consistent low carbohydrate diet (no cheating) helps balance blood glucose. Cats can enter remission while treated with any type of insulin; however, many doctors find that cats have better glycemic control with long-acting products.
There are several veterinary approved insulin products available. In addition to the commonly used medications, there are a couple of newer drugs. Glargine, is a human medication that is long acting and maintains more consistent glucose levels. Detemir is a synthetic insulin that has a long duration of activity. Both of these newer insulin products can help promote remission in cats by achieving quick glucose control.
Acarbose is a medication that decreases the absorption of glucose from the intestinal tract into the blood stream. It can be used with insulin or oral medications to achieve better overall glucose control. Acarbose is used in cats that cannot eat a low carbohydrate diet due to other medical conditions. Blood glucose is decreased significantly in cats eating high carbohydrate diets when acarbose is given orally twice a day.
- Timing of glucose regulation and remission
Unfortunately, the longer a cat is diabetic, the less likely remission will occur. Achieving glucose control quickly increases the chances of remission. Cats that have diabetes for more than six months are less likely to go into remission. This is because the increased blood glucose injures cells in the pancreas that produce insulin, preventing the cat’s body from ever controlling glucose without an external source of insulin.
One study found that cats with good glucose control within six months of diagnosis had a 60 to 80% chance of remission as compared to 30% for cats that started insulin therapy more than six months after diagnosis.
- Body condition score
Overweight cats are less sensitive to the effects of insulin, so cats with a healthy body condition score (5 out of 9) respond better to diabetes therapy. Obese diabetic cats should be fed a diet that promotes 1 to 2% loss of body weight per week. This slow, regulated weight reduction improves insulin sensitivity, may reduce the amount of insulin required, and increases the probability of long-term remission.
- Other factors
Cats that require a lower insulin dose to control glucose levels are more likely to enter remission, as are cats that become diabetic at an older age. Cats with low cholesterol levels also do better.
What is the bottom line with diabetic remission in cats?
Staying in remission is likely, as long as the cat remains basically healthy and infection free and maintains a good body condition score while eating a low carbohydrate diet. Remission can happen! But, remember that diabetes is still a disease that is more likely to be controlled than cured.