Feline Diabetes Mellitus: NAVLE Study Guide for Diagnosis and Management

Feline diabetes is a NAVLE staple. The key things that distinguish cat DM from dog DM: cats get Type 2 (insulin resistance + islet amyloid), cats can go into diabetic remission, cats use glargine as first-line insulin, and the plantigrade stance is unique to diabetic neuropathy in cats. Know these distinctions cold.

Pathophysiology

Cats develop Type 2 DM—islet amyloid polypeptide (IAPP) deposition in pancreatic islets combined with peripheral insulin resistance. Obese male neutered cats are at highest risk. Predisposing conditions: obesity, physical inactivity, glucocorticoid therapy, acromegaly (up to 25% of diabetic cats may have elevated IGF-1—screen refractory cases), pancreatitis, and concurrent UTI (glucosuria promotes bacterial growth).

Stress hyperglycemia: Cats can have blood glucose >300 mg/dL from stress alone. Fructosamine distinguishes true DM from stress hyperglycemia—fructosamine reflects 2–3 week average glucose and is not affected by acute stress.