Diabetes in cats: symptoms, treatment and the chance of remission
Diabetes is one of the most common hormonal diseases in cats. It sounds like injections for life, and for many cats it is, but with early diagnosis, the right treatment and a low-carbohydrate diet, a significant proportion of them stop needing insulin.
What it is and which cats it affects
Feline diabetes closely resembles type 2 diabetes in people: the pancreas produces insulin, but the body responds poorly to it, and over time the pancreatic cells that make it become exhausted. The most important risk factor is obesity, which reduces sensitivity to insulin. Males, middle-aged and older cats, inactive and indoor cats and some breeds, such as the Burmese, are also at higher risk. Some medicines, such as long-acting corticosteroids and the progestogens used to stop heat, can trigger it, as can other diseases such as pancreatitis or acromegaly.
The symptoms
The classic ones are drinking a lot and urinating a lot, with bigger or more numerous litter clumps, eating with a bigger appetite and, despite that, losing weight. Some cats develop diabetic neuropathy, which makes them walk on their hocks, with the back legs lower, as if walking on their heels; they may also have weak legs or difficulty jumping. The coat may look unkempt. If diabetes is not treated, it can progress to diabetic ketoacidosis, a serious emergency with vomiting, loss of appetite, dehydration, lethargy and sometimes breath that smells of acetone or overripe fruit.
How it is diagnosed
With blood and urine tests. High blood glucose on its own is not enough, because in cats the stress of the visit can push it up a lot temporarily. So fructosamine is also measured, which reflects average glucose over the last one or two weeks, and the urine is checked for glucose. Kidney and liver function are reviewed too, thyroid hormone in older cats, and the urine is checked for infection, which is common in diabetics, or ketones, which would indicate ketoacidosis. The diagnosis is confirmed by putting the symptoms together with these results.
Remission: the realistic goal
Unlike dogs, a significant proportion of diabetic cats can go into remission, meaning they no longer need treatment while keeping normal glucose levels, sometimes for years. ISFM guidelines indicate that the chances are higher when treatment starts soon after diagnosis, good glucose control is achieved in the first weeks and months, a low-carbohydrate diet is used, the cat loses the excess weight and medicines that worsen diabetes are avoided. Remission rates vary widely between studies, from under a third to most cats in the most intensive protocols. Ask your vet: remission is a goal to pursue from day one.
Treatment with insulin
Most diabetic cats are treated with insulin injected under the skin, usually twice a day, at mealtimes. It can be daunting, but the needle is very fine, the injection goes into the loose skin of the neck or flank and most cats do not even notice it, especially if it comes with food or a treat. The vet will choose the type of insulin, the starting amount and how to adjust it; the dose is never changed on your own. You will learn to keep the insulin in the fridge, not to shake it if the manufacturer says so, to use syringes matched to its concentration and to note down every dose. The first few days are hard; within a few weeks it becomes a one-minute routine.
An oral treatment for some cats
In recent years, oral medicines for feline diabetes have been authorised in Europe, from the SGLT2 inhibitor family, which make the cat pass excess glucose in the urine and are given once a day. They are an option for some newly diagnosed cats that still produce insulin and have no ketones, and can avoid injections. They are not suitable for every cat and have their own risks, such as a type of ketoacidosis that can go unnoticed, so they require careful selection and close monitoring, especially at the start. It is a decision made with the vet after the initial blood tests.
Diet and weight
Diet is part of the treatment. Veterinary diets for diabetic cats are high in protein and low in carbohydrates, and help control glucose and achieve remission. Wet food usually has fewer carbohydrates than dry food. Meals should be regular, at the same times and matched to the insulin, with no unplanned treats. If the cat is overweight, losing weight gradually is essential, always at the pace set by the vet, because in cats losing weight quickly can cause hepatic lipidosis.
Hypoglycaemia: what you need to recognise
If the cat gets more insulin than they need, does not eat after the injection or goes into remission without the dose being adjusted, blood sugar can drop too low. The signs are weakness, wobbliness, disorientation, tremors, strange behaviour and, in severe cases, seizures or loss of consciousness. It is an emergency: rub a little honey or syrup on their gums, without pouring liquid into the mouth if they are not swallowing well, and go to the vet immediately. If you are not sure whether you have given the insulin, do not repeat the dose: it is safer to skip one than to give two. And if the cat does not eat, do not give the insulin without asking.
Monitoring at home and at the clinic
Check-ups are frequent at first, to adjust the dose with glucose curves, which involve measuring glucose several times through the day, and with fructosamine. More and more families measure glucose at home with a veterinary glucometer, using a drop of blood from the ear, or with continuous glucose sensors that stick to the skin and last a few days; at home the readings are more reliable because the cat is not stressed. Also watch how much they drink, how much they urinate, their weight and their appetite: if they start drinking less, they may be going into remission and the dose may need lowering.
What it costs
As a guide in Spain in 2026: initial diagnosis with blood tests, fructosamine and urine, 150 to 300 €; insulin, 30 to 70 € a month depending on type and amount, plus syringes; oral treatment, in a similar or slightly higher range; a glucose curve at the clinic, 60 to 150 €; a continuous glucose sensor, 50 to 80 € each; diabetic diet, 30 to 70 € a month. Diabetic ketoacidosis with hospitalisation can cost 800 to 2,500 €. A well-controlled cat is much cheaper, and happier, than one in and out of the emergency clinic.
Feline diabetes resembles type 2 and is closely linked to obesity. Drinking, urinating and eating a lot while losing weight are the classic signs. With early treatment, good control, a low-carbohydrate diet and gradual weight loss, a significant proportion of cats achieve remission.
Educational content from Michipedia, translated from the Spanish original. It does not replace the advice of a vet or a feline behaviour specialist. Every cat is an individual.