Diabetes In Cats Defined

Because of the increase in cases of diabetes in people, the American Diabetes Association declared November to be Diabetes Awareness Month. Sadly, veterinarians are seeing a steady increase of diabetes in pets as well. That's the bad news. The good news is that it is a condition that can be successfully treated with commitment from the veterinarian and the owner.

Diabetes Mellitus is the most common form of diabetes found in cats, and is the second most common endocrine disease in cats. It is estimated to affect one in 400 cats, is found in more males than females, and is a common ailment of middle-aged to senior cats.

Diabetes is a disease of the pancreas. In cats with normal glucose metabolism, food is broken down into components that can be used by the body. Carbohydrates are converted into various sugars including glucose. Glucose is absorbed from the intestines into the bloodstream, providing the body cells with energy. Glucose can only enter most cells if the hormone insulin in present. There are specific cells, called beta cells, located within the pancreas that manufacture insulin.

Diabetes mellitus, or "sugar diabetes" as it is sometimes called, is caused by a lack of insulin available to the cells in the body. This is due either to insufficient insulin production by the pancreas, or by the body cells failing to respond to the insulin. As a result, blood glucose levels are too high and the body cells cannot absorb enough to provide adequate energy.

The most common type of diabetes mellitus found in cats is Type II, in which some insulin producing cells remain in the pancreas. They are either not producing enough insulin for the body to adequately process glucose, the secretion of insulin is delayed, or the cells are resistant to it. Just as with humans, obesity is a predisposing factor to diabetes. The tremendous increase in overweight and obese cats means that more and more cases of diabetes are being diagnosed. It's important to remember that a cat just three pounds over ideal weight is considered obese.

There are clinical (observable) signs that may indicate your cat has, or is developing, diabetes. The most common sign is drinking a lot of water and an increase in urination. There may also be increased incidents of inappropriate urination outside the litterbox and/or on furniture. Sudden weight loss, especially with an increase in appetite, can be a warning sign. As the disease advances, the cat will become increasingly lethargic and will have a dull coat.

If you are concerned that your cat may have diabetes, you should contact your veterinarian. During the appointment, it's important that you relay accurate information about your cat's signs and symptoms and are able to list all the medications and supplements your cat is currently taking. Your veterinarian will be able to do a complete physical exam and run lab work to help properly diagnose your cat.

If your cat is diagnosed with diabetes, it is very important to maintain a good relationship with your veterinarian and the entire team at your animal hospital. With a combined commitment from you and your veterinarian, your cat's diabetes can be easily treated.
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Coming Next Time: Diagnosis and Treatment of Diabetes

Case of the Week: Max

Max is a sixteen-year-old Siamese mix. His owner brought him into the clinic because he had stopped eating and drinking and was drooling constantly. On examining him, I found that he was thin, very dehydrated and had a fever. I also saw a large ulcer on his tongue. My first thought was that it was likely he had severe chronic kidney disease and a poor prognosis. We drew blood and urine samples from him and did a panel to evaluate his organ and immune system functions.

His blood test results were surprisingly good. His kidney values were increased, but only a little above normal and he was concentrating his urine fairly well. These results indicated that his kidneys were still functioning well but that Max was dehydrated. I also found that his protein levels and one of his white blood cell counts were increased, which indicated an infection in his body.

It was at this point that Max's history became as important in diagnosing his problem as his blood tests and physical exam. Max's owner had recently adopted a new cat into their home. Max had not had any vaccines since he was a kitten. Therefore, he was not protected against the common viruses that are very contagious and widespread among cats, especially those in shelters. It is very difficult to test for the Herpes or Calici viruses that cause upper respiratory disease in cats. However, Max's symptoms - lethargy, not eating, running a fever, and an ulcer on his tongue - were consistent with upper respiratory disease.

Max received intravenous fluids at the clinic for two days and recovered slowly. We gave him subcutaneous fluids (under his skin) for a few more days and he gradually began eating and grooming again.

Vaccinations are important in all cats to help prevent disease. Because of widespread vaccination, we rarely see Panleukopenia (Distemper) or Rabies in cats in this country. The Herpes and Calici viruses that cause upper respiratory disease are very contagious and stable viruses that still cause problems in many cats. However, severe disease from these viruses are usually only seen in young cats and cats that have not been well vaccinated. Cats that are current on their vaccines have good immunity to these viruses and show minimal signs of illness when exposed.

It's important that owners not become complacent about their cats protection. Even indoor cats can be exposed to viruses. Always discuss with your veterinarian what vaccines are best for your cat.

For more information and guidelines for vaccinations throughout your cat's life, see our Life Stages Health Care Recommendations on our website.

Dr. Judy Karnia

Case of the Week - Midnight

Midnight is an eight and a half year old domestic short hair cat. She first came into the clinic nine months ago because she was straining to urinate and defecate. I examined her and found that she was constipated and obese. We want cats to be a healthy 5/9 on our body condition score scale. Midnight was an 8/9. Her bladder was too small to obtain a urine sample, but I suspected a urinary tract infection due to her symptoms. We gave her an enema and started antibiotics and medication to soften her stool. We also advised her owner to start feeding canned food and started her on a prescription diet food to start weight loss and relieve her constipation.

Two weeks later at her progress exam, Midnight had improved and was urinating and defecating better. However, a urinalysis showed that there was still blood in her urine so we ran more tests. Her bladder and kidneys appeared normal on an ultrasound and a urine culture ruled out bacterial infection. Since no underlying cause could be found, I diagnosed her with "cystitis" which is inflammation of the bladder. In many cases, we do not know the cause of the cystitis but it can be caused and/or made worse by stress. Stress in a cat's life can be very subtle and can be related to their environment, other animals, their diet, or painful medical conditions.

I prescribed Metacam for Midnight to help ease the inflammation and discomfort in her bladder. Metacam is a non-steroidal anti-inflammatory medication. As with any medication, repeated and long-term use may cause some side effects. If we make sure we use proper dosages and the cat is monitored well, Metacam relieves discomfort in many cats with cystitis and arthritis.

Midnight immediately started feeling much better. She was much more active. Her owner said that she had noticed stiffness in Midnight's hind end previously, but she was now moving much better.

At her progress exam a month later, Midnight was still doing very well. She was urinating and defecating normally. She no longer needed stool softeners. Her diet was doing well and she had lost almost a pound by this point. However, her urinalysis showed that she still had blood in her urine indicating that her cystitis was not fully resolved.

In order to try to improve this, we started Adequan injections to help the bladder and the likely arthritis. Adequan is polysulfated glycosaminoglycans; these are normal components of joints and the bladder wall. We give it as an injection under the skin - weekly or bi-weekly - then fewer injections as the cat improves.

Midnight is currently given Adequan injections once monthly and Metacam every fourth day and continues to do well. She has lost almost two pounds and is active and feeling well. We needed to switch her prescription food to a low calorie food with high protein rather than high fiber. This has produced more regular bowel movements for her but still helped with her continued weight loss.

Nearing nine years old, Midnight is now classified as a senior cat. Like human senior citizens, it is common to see multiple problems in senior cats. Keeping a healthy weight and feeding quality cat food helps all aspects of their health. But even trim senior cats can be plagued with troublesome and intersecting problems. Many times we have to prescribe multiple medications to address the various problems and make sure we are treating them as well as possible.

Dr. Judy Karnia

Senior Feline Health Care - Diagnostic Testing

As we mentioned in our senior wellness blog, many of the diseases and conditions that commonly develop in senior cats are more easily managed when they are caught in their early stages. This helps maintain or even improve your older cat's quality of life.

In this blog, we will explain in a little more detail what exactly the tests we run tell us about your cat's health.

Many of the same technologies and medical diagnostic testing that help humans live longer, healthier lives are also available to your cat. Even a few standard tests allow us to gather a wealth of information about the well-being and health of your cat. These tests become increasingly important as your cat continues to age.

The most common lab test we run in our clinic is a combination blood panel consisting of a complete blood count and blood chemistry. A Complete Blood Count (CBC) is a series of tests that evaluate the number of cells in circulation in the blood. White blood cells, WBC, help fight infection and inflammation and can increase with cancer. Red blood cells, RBC, carry oxygen to the tissues. Platelets allow clotting of the blood and are another indication of the health of the bone marrow. Overall, the CBC tests for anemia, infection, inflammation and the health of blood cells and the bone marrow.

A blood chemistry panel is performed to get an initial overview of the health and function of body organs. This panel surveys many of the organ systems of the body to make sure they are working properly. Our chemistry test checks the following organ functions: liver, kidney, pancreas, muscle, bone, thyroid and electrolytes.

For many conditions, such as chronic renal disease and diabetes mellitus, a urinalysis should also be run to provide a complete picture of organ function. For example, in verifying renal disease, the specific gravity - or concentration - of urine is a key diagnostic tool in addition to the blood chemistry numbers. In diagnosing diabetes, glucose levels in the urine are examined.

Finally, we recommend radiographs (x-rays), first to establish a baseline at a younger age, and then regularly to monitor any changes or developments. Cats do develop arthritis, but as with many illnesses, they hide their discomfort and it's not always readily apparent until the condition becomes severe. There may be subtle signs, such as taking extra steps to get places, jumping from floor to stool to bed instead of straight from floor to bed, or refraining from jumping at all. Arthritis pain can be managed with a variety of different treatments, including a specialized diet.

Ultimately, the tests performed are designed to ensure the best quality and longevity of life possible for your cat.

Case of the Week: Margie

To start off Senior Health Care Month, our case of the week focuses on Margie, our clinic cat. I adopted Margie three and a half years ago, two weeks after we opened the clinic. She had been living at Save Haven cat shelter for years and her age and history were unknown. She was thought to be around twelve at the time and was definitely a senior cat. She did not like living with the other cats in the house and spent all her time in a cat condo cage. Even though the door to the cage was left open, she never left it and did not allow other cats inside. As I am partial to calico cats, I was drawn to her and she yelled at me to take her home with me.

Safe Haven let me borrow her cage to set up in my office so Margie would feel more at home. It took her a few weeks to start venturing out of the cage and then a few months to take her first step outside my office. She eventually became comfortable enough to hang out at the front desk and wander the clinic, although she will still only walk to the back of the clinic when it is quiet. She is a cranky old lady that will bite if feeling annoyed. But she loves to rub her face on shoes and lick my computer and hand while I type.

Her medical problems have grown over the years. She needed a dental cleaning when she first arrived. She has had on and off vomiting and diarrhea, which has required different diet choices. Two years ago I diagnosed her with early chronic kidney disease and we switched her diet to include some of the renal prescription diets. Routine abdominal radiographs indicated mild arthritic changes in her hips and we started her on Adequan injections to help her joints. She became livelier and even started chasing imaginary bugs.

Her kidney disease gradually worsened. Six months ago, her kidney values had increased to moderate levels and she was not eating well. We started giving her fluids under her skin to improve her hydration and help her feel better. We also started her on Mirtazapine, an appetite stimulant that is given twice a week. Her appetite picked up and she became more active.

In the past month, she has declined in her activity level. Suspecting her kidney disease was worsening, I performed another physical exam on her and found a mass in her abdomen. We called Dr. Greene, an internal medicine specialist, into the clinic to perform an ultrasound. He found multiple tumors through her abdomen. Dr. Greene aspirated the tumor, using a needle to select a small sample to send to a pathologist. The pathologist diagnosed Margie with sarcoma, an aggressive malignant cancer that has no treatment except for removal. However, because the cancer had already spread throughout her abdomen, removal was no longer an option. It was a disheartening diagnosis.

So far, Margie is in good spirits. She has good days when she eats well, talks to me as much as usual, and rubs her face on everything she can reach. And she has days when she sleeps on the chair in my office all day. Her abdomen is slowly filling with fluid and she is starting to have difficulty jumping onto the chair. We continue her treatments for her kidney disease, trying to keep her feeling as well as possible.

Having a senior cat is difficult at times but so rewarding as well. Many people are reluctant to adopt an older cat, wanting to raise a cat up from a kitten. Yet so many older cats are just like Margie. They can certainly be aloof at first, reserved and distant as many cats are toward strangers. But given half a chance, they can become devoted pets. They have endearing personalities and lots of love to give is someone will open up to them.

The day when we will have to say goodbye to Margie is fast approaching. She has been a joy to have here at the clinic with us and we will miss her cranky demands for food and treats. She has been a great clinic cat, and I think she has really enjoyed her time here. I have no doubt that the last few years of her life were better at her new home, and we are better for having her at the Scottsdale Cat Clinic.

Dr. Judy Karnia

Senior Cat Wellness Care

September is National Senior Health Care Month and we thought this would be a great opportunity to discuss the senior health of your cat. Advances in veterinary medicine and knowledge mean that cats are living longer lives. Not that long ago, a 15-year-old cat was a remarkable survivor, but these days that cat still has several good years of life left.

So at what age is a cat considered a "senior"? According to the American Animal Hospital Association's wellness guidelines, a cat is considered to be "mature" or middle-aged at just 7-10 years of age. While that may seem early to be labeled mature, many age equivalency charts match 7 years old in a cat to mid- to late-40's in a human. A senior cat is between 11 and 14, and their geriatric, or "golden years", start at 15+.

Just as with humans, as cats get older, wellness visits become more important. As cats age, they are at risk for a number of illnesses and conditions. Most of these are more easily managed when caught early. Regular physicals and diagnostic lab work are essential to keep your senior kitty in the best health possible for a long as possible.

Starting in their mature years, we'll start looking for age-related changes. A full physical exam every six months is key to maintaining optimal health. We also recommend full lab work every other year, which includes a complete blood count, blood chemistry panel, electrolytes, thyroid and urinalysis. We will take your kitty's blood pressure during her exam to make sure no problems are developing there. We also like to establish a baseline on x-rays of the chest and abdomen so any changes are more easily recognized. We also discuss your cat's changing diet needs as well as any changes in behavior or routine that you have noticed.

Once your cat reaches her golden years, we will look more closely at lab tests and behaviors, anticipating changes as she continues to age. We perform tests more frequently, running full lab work every year and taking x-rays every other year, because we know that your cat is more vulnerable at this stage in her life.

The goal of senior care is simple. We want to help you maintain the highest quality of life for your cat and thereby enhance the bond that we all share. Together we can make the senior years the most rewarding years for you and your cat to have with each other.

See our Life Stages Health Care Recommendations page on our website for specific details on wellness at all stages of your cat's life.