Nutrition and Pancreatic Disease in Cats

By Canadian Academy of Veterinary Nutrition (CAVN), Erico Ribeiro, MV, PhD, DVSc Candidate, ECVCN Resident

What is the pancreas?

The pancreas is an organ located close to the liver, the stomach, and the small intestine. It has two separate and distinct functions: endocrine functions (functions associated with hormone production) and exocrine functions (functions associated with digestive enzyme production).

As an endocrine organ, the pancreas controls blood sugar levels by secreting insulin and glucagon hormones. As an exocrine organ, it aids in digestion by secreting lipase, amylase, and other digestive enzymes.

What pancreatic diseases in cats can be affected by nutrition?

The most common diseases that affect the pancreas in cats are pancreatitis, diabetes mellitus (DM), exocrine pancreatic insufficiency (EPI), and insulinoma. Because the pancreas is so important for digestion and nutrient metabolism, nutritional changes will benefit cats with pancreatic disease. Dietary modifications can improve or control the clinical signs, depending on the pancreatic disease and its effects on digestion, nutrient metabolism, or both.

How can nutrition affect cats with pancreatitis?

Pancreatitis is a common pancreatic disease in cats, but it is usually not possible to identify the cause. It is often associated with other conditions, including diabetes mellitus, hepatic lipidosis (fatty liver), and chronic inflammation in the GI tract (e.g., inflammatory bowel disease). In cats, it is not clear if nutrition is essential for its prevention, but it is vital during treatment.

"There are no specific diets for pancreatitis, so offering different diets 
might be necessary to identify which one your cat will adapt to."

Unlike dogs, cats do not seem to have pancreatitis because of a high-fat diet. However, some veterinarians prefer avoiding excessive fat during treatment. There are no specific diets for pancreatitis, so offering different diets might be necessary to identify which one your cat will adapt to.

Because other diseases that respond to nutrition are commonly associated with pancreatitis (e.g. inflammatory bowel disease or diabetes), your veterinarian may recommend a diet specific to those conditions.

Since cats with pancreatitis can be in pain and not eat well, offering different diets might help to ensure they do not lose weight. Appetite stimulants and treatments to control pain can be used and should be discussed with your veterinarian if there are changes in your cat's appetite. A cat that isn’t eating enough calories can develop a severe liver condition called hepatic lipidosis (fatty liver).

If your cat is hospitalized, nutrition support with a feeding tube might be required to ensure the food and calorie intake are ideal. Depending on the cat’s response, it might go home with the feeding tube.

How can nutrition affect cats with diabetes mellitus (DM)?

Cats with DM usually require insulin treatment to control blood glucose levels, since the pancreas is not doing it properly. However, diabetic cats can go into remission (no longer requiring insulin) depending on treatment results, ability to achieve an ideal body condition (usually requiring weight loss), and how long they have had diabetes. Any weight loss must be controlled or it can lead to other complications.

"There are no specific diets for pancreatitis, so offering different diets 
might be necessary to identify which one your cat will adapt to."

Since cats are usually not good drinkers, diabetes can predispose them to dehydration because they urinate more. Using wet or canned foods can help increase water intake. Adding water to dry food/kibble helps, but it may not have the same effect. It can also help to add multiple water bowls throughout the house and try different sizes and formats, such as water fountains.

Diet changes can improve glucose levels (glycemia) after meals and thereby lower the amount of insulin the cat requires. There are two diet approaches for diabetic cats:

  • a diet with high fiber and moderate starch (carbohydrate), similar to those used for dogs and humans; 
  • or a diet with minimal carbohydrates (low in starch and fiber). 

Either diet type can be used to promote glucose control and weight loss to achieve remission. Carbohydrates (starch), protein, and fat produce glucose after absorption, so it is critical to adjust food ingredients and amounts, as well as insulin dose, for a good response.

Diets for diabetic cats avoid sugars because they are easily digested and can lead to a quick glucose peak. Avoid diets, treats, and "people foods" that contain sugars or sweeteners, such as honey, fruits, and syrups.

Some cats may require a specific diet because of another disease (e.g., chronic kidney disease). It might be more challenging, but achieving adequate glucose control with other diets is possible. In these situations, it is essential to work closely with your veterinarian to monitor and adjust the diet and insulin dose.

How often should I feed my diabetic cat?

Cats are not usually as adapted to be meal-fed as dogs. This preference affects their feeding schedule and their recommended insulin type.

Consistency in the diet and routine is critical for diabetic cats. It is essential to measure the daily food amount with a digital (kitchen) scale to avoid fluctuations. Keep a food diary that records the time and amount of food offered; it will help your veterinarian to adjust the treatment more precisely.

Any additional foods or treats that your cat receives will affect glucose levels. The importance of these extra foods will depend on the nutrient profile and the amount fed.

Feeders with microchip readers and automatic feeders can be helpful for feeding during work hours or for multiple pets.

What should I do if my cat has low glucose levels (hypoglycemia)?

Hypoglycemia can be life threatening. If your cat experiences episodes of hypoglycemia, discuss it with your veterinarian. It is a sign that the treatment, including the diet, should be reviewed.

  • If your cat can swallow without difficulty: Offer small amounts of glucose solution, honey, or corn syrup.
  • If your cat cannot swallow appropriately: Rub a small amount of glucose solution, honey, or corn syrup into the gums or under the tongue. Then reach out to your veterinarian or emergency service. Do not offer any liquids by mouth. There is a high risk of the cat breathing in the liquid, which can cause severe respiratory complications.

How can nutrition affect cats with exocrine pancreatic insufficiency (EPI)?

In cats with EPI, the pancreas does not produce digestive enzymes (pancreatic secretions). To treat this problem, your veterinarian will provide enzyme supplements for your cat. Diet changes can also be necessary, depending on the response to enzyme treatment.

Diet Balance

  • Because digestion is affected, it is best to use a high-quality diet that is very digestible. These diets usually contain low amounts of fiber, because fiber affects the digestion of other nutrients.
  • The diet's fat content must be adjusted based on your cat's response. After diet changes, your veterinarian will monitor fecal color and consistency with a fecal scoring chart. Pale stools can be a sign of fat maldigestion (steatorrhea).
  • Fat provides more energy (calories) than protein or carbohydrates, but also requires more time for digestion and absorption. For that reason, the diet may be adjusted to address weight gain or fat maldigestion.
  • Protein and carbohydrates also require pancreatic secretions, but are usually less affected than fat, so are of less concern when selecting an appropriate diet for cats with EPI.

Nutrient Absorption

The pancreas is also critical for cobalamin absorption (vitamin B12). Cats with EPI require cobalamin supplementation, even when receiving pancreatic enzymes. Oral or injectable cobalamin supplementation are good options. A blood test that measures cobalamin level in the blood is essential to adjust the treatment if necessary. For more information about cobalamin, see the handout “Cyanocobalamin (B12 or Cobalamin)”.

Folate (vitamin B9) in the blood might be elevated in cats with EPI, due to increased production by intestinal bacteria. Bacteria also use cobalamin, so measuring both folate and cobalamin is ideal.

There are no specific diets for cats with EPI. Low fiber and moderate fat (depending on each cat) is a good initial combination. Your veterinarian will monitor your cat’s response, and may need to make multiple changes and adjustments to the diet type and enzyme supplementation to achieve a good response.

How can nutrition affect cats with insulinoma?

Insulinomas are pancreatic tumors that can increase insulin production and cause low blood glucose (hypoglycemia). Diets that prevent high peaks in glucose levels can benefit cats with insulinoma. Veterinary diets with high fiber and specific carbohydrate sources and amounts can contribute to gradually absorbing glucose. Avoiding a high glucose peak also prevents a quick release of insulin and resulting hypoglycemia.

Feeding management for insulinoma is essential: smaller and more frequent meals are recommended to slow glucose absorption and reduce insulin release.

If your cat has low blood glucose levels, even with an adequate diet and feeding adjustments, follow the steps outlined above for addressing hypoglycemia.

What should I do if my cat has a pancreatic disease and is not eating?

Since some pancreatic diseases can lead to pain and vomiting, your cat's appetite might be reduced. Feeding smaller and more frequent meals may help your cat eat the daily amount and tolerate it more easily. If you notice your cat is not eating and is losing weight, contact your veterinarian for support. Cats are not well adapted to using fat as an energy source. When they lose weight quickly, they can get a fatty liver (hepatic lipidosis), a life-threatening condition that requires appropriate treatment.

While wet/canned foods are a great option to improve the appetite, not every cat is adapted to them. If the food is complete and balanced, it can be used as the only food or combined with the dry (kibble). A complete and balanced diet will have an AAFCO statement saying that it is appropriate for long-term feeding. Homemade diets can also be a good option if your pet has multiple medical conditions that are not easily managed with commercial food. However, like wet foods, not every cat will eat a homemade diet.

Using some very appealing foods as toppers or mixers (e.g., pet foods that are appropriate for kittens or canned/wet foods) might improve your cat's appetite, as they usually have high protein and fat. Adding water or warming the food can also help with food intake. Usually, a temperature close to body temperature is the best. Some cats also benefit by feeding in different bowls or less stressful environments.

A board-certified veterinary nutritionist (ACVN) can formulate a complete and balanced homemade diet, helping with food and water intake. Your veterinarian can help you work with an ACVN online if there is not one in your area.

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