Download cats and diabetes mellitus – what`s diet got to do with it?

CATS AND DIABETES MELLITUS – WHAT’S DIET GOT TO DO WITH IT?
Lisa P. Weeth, DVM, DACVN, MRCVS
Weeth Nutrition Services
Feline diabetes mellitus (DM) is one of the most common endocrine disorders diagnosed in companion
cats worldwide.1 The prevalence of this disorder appears to vary by region.2-7 The United States has the
highest overall prevalence of feline DM with an estimated 124 cases per 10,000 cats2, while in Sweden
only 11-21 cases of DM are seen per 10,000 cats.3,4 There is also a strong breed predisposition with
Burmese cats having a higher risk of developing DM compared to the general feline population4,5,7; for
example the overall prevalence of feline DM in Australia is estimated at 74 cases per 10,000 cats, but for
5
Burmese the prevalence increases to 221 cases per 10,000 cats.
Low activity, increasing age,
2-7
neutering, obesity, and being male are also considered risk factors for development of feline DM.
Diabetes mellitus is a disorder of glucose metabolism that involves either insufficient insulin production
(often referred to as Type 1 DM) or a peripheral insulin resistance (often referred to as Type 2 DM), or a
combination of the two. In dogs, DM is most often a relative insulin deficiency due to loss of beta cell
activity resulting from immune-mediated destruction of Islet cells or pancreatitis1,8, though it is
exacerbated by other concurrent diseases such as hyperadrenocorticism 9, hypothyroidism 10, and
obesity.11 In contrast, feline diabetes typically occurs due to a peripheral insulin resistance in overweight
or obese individuals, though having a history of repeated corticosteroid administration, recurrent
pancreatitis, or acromegaly, or being a Burmese cat can decrease insulin secretion and interfere with
insulin sensitivity.1,12,13 The difference in disease pathogenesis between dogs and cats can make the
initial dietary recommendations dramatically different in the two species. The majority of diabetic dogs
have an absolute requirement for twice daily insulin injections lifelong and diet plays a secondary role to
medical management, in contrast diabetic cats, especially those considered “pre-diabetic or are in early
diagnosis and treatment, may be able to maintain glycemic regulation without the need for additional
medical treatment when fed a higher protein, reduced carbohydrate diet 14,15 and fed to promote gradual
16
weight loss to a more lean body condition if obese.
Diet and Diabetes Prevention
Obesity is the most consistently found diet-induced risk factor for development of DM in cats. 2,3,7,12
Macronutrient composition, specifically the level of fat in the diet, also appears to have a large influence
17
on development of obesity in cats, while dietary carbohydrate did not. Adipocytes secrete hormones and
18
cytokines that can decrease insulin sensitivity and while consumption of dry diets is often implicated in
the development of DM, low physical activity rather than diet type was shown to be a more significant risk
factor for DM in cats.19 Overweight and obese, non-diabetic cats can have impaired glucose metabolism
irrespective of diet type and carbohydrate content20-23, though modification of the type and amount of
carbohydrate can influence postprandial glucose elevations in health adults.23-26
Prevention of obesity, and treatment of obesity when present, can minimize risk of DM development in
cats. Food intake and body condition should be monitored regularly at home and recorded during annual
wellness examinations to identify at-risk individuals. Owners should be counseled to encourage regular
physical activity among their companion cats.
Diet and Diabetes Management
Specific diet changes are often attempted at the time of initial diagnosis, but administering twice daily
injections while making changes to the diet and daily feeding regime can be daunting for many caregivers
and result in food refusal by some cats. Additionally, the optimal diet for management feline diabetes will
vary with underlying etiopathogenesis and stage of disease. Cats with decreased beta function due to
chronic, recurrent pancreatitis or with beta cell depletion due to glucose toxicity and amyloid deposition
within the pancreas27 will require twice daily insulin administration lifelong. 28 Either a higher protein, lower
carbohydrate or a moderate protein and carbohydrate, higher fiber diet are effective at aiding in glycemic
regulation in these patients when given with twice daily insulin. 14,15,29,30 In newly diagnosed diabetic cats,
long acting insulin can normalize blood glucose levels and help lead to euglycemia without parenteral
30,31
insulin therapy (i.e., diabetic remission) irrespective of diet type.
Though obese, diabetic cats fed
higher protein, lower carbohydrate diets in an amount to promote weight loss may experience improved
glycemic control and diabetic remission sooner.14-16
Diabetes mellitus can increase daily energy requirements though the extent will vary with each patient
depending on severity of disease. Even in overweight or obese cats, the initial recommendation should
still be for weight maintenance until glycemic control is established. This will allow the veterinarian and
caregiver to evaluate the efficacy of insulin therapy independent of intentional calorie restriction. Initially
feed 10-15% above pre-diabetes requirements and recheck weight regularly. This starting amount can be
0.75
based off the calculated maintenance energy requirement (MER) of 70xBW kg x1.2 (neutered adult cat
factor), but as individual cats can vary up to 50% above or below this amount even without concurrent
disease, evaluating current and previous dietary intake may provide a more accurate starting estimate.
Weight and body condition should be measured and recorded at each recheck examination with
adjustment in energy intake as needed.
In overweight or obese diabetic cats, a modest reduction in energy intake can then be made each day to
help achieve a rate of no more than 1% of body weight lost per week. Loss of adiposity may help improve
exogenous and endogenous insulin efficacy through a decrease in peripheral insulin resistance. Frequent
re-evaluations of weight and clinical signs of disease are required to monitor for any needed change in
insulin dosage.28 Hypoglycemia can occur if the overweight or obese diabetic cats lose weight without a
corresponding decrease in insulin dosage.33
The initial treatment recommendations for diabetic cats should concentrate on owners becoming
comfortable and competent with insulin therapy and making adjustments to the daily feeding regime
rather than making any specific diet changes. Meals should be offered twice daily to coincide with insulin
administration to help prevent life-threatening hypoglycemia. For finicky cats or caregiver that have
difficulty with a twice daily feeding schedule, some flexibility in feeding regime may be possible as longer
acting insulins meals to be spread out over 2-4 feedings each day.
Once the cat is stable or if medical management alone is not controlling blood glucose levels during the
day then transitioning to a higher protein, lower carbohydrate diet should be considered to aid in glycemic
regulation. Obese cats should be transitioned to a higher protein, lower carbohydrate diet formulated for
active weight loss. Diet transitions should occur slowly over 7-14 days to ensure adequate energy intake
and acceptance of the new diet. There are a number of commercially-available veterinary therapeutic wet
and dry diets that meet the profile recommended dietary profile for both weight maintenance and weight
loss in cats with DM. Over-the-counter (OTC) dry cat foods are often too high in dietary carbohydrates
due to manufacturing requirements for higher starch contents for kibble formation, though OTC wet foods
do not have this manufacturing limitation and may be suitable for weight maintenance in diabetic cats not
requiring concurrent weight reduction.
Summary
Dietary and medical management of Diabetes Mellitus have the same therapeutic goals: minimize clinical
signs related to hyperglycemia, avoid life-threatening hypoglycemia, maintain lean muscle mass, and
improve quality of life parameters for patient and caregiver. In the face of inadequate insulin production,
twice daily parenteral insulin is often required, but feeding a higher protein, lower carbohydrate diet to
cats with DM may help lower insulin requirements and promote diabetic remission.
There is no one perfect diet strategy and recommendation should be tailored to the individual’s medical
history, food preferences, and concurrent disease states to ensure patient acceptance and owner
compliance. An individual cat’s needs may also change throughout the course of disease and monitoring
body weight, body condition, musculature, and clinical signs of DM at each visit are good indicators of
overall glycemic regulation. Collecting diet information should also be done at each office visit to review
owner compliance and identify any gaps or inconsistencies in dietary management that could lead to
future problems.
References
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