DVM Iida Niinikoski
Diabetes mellitus is a fairly common disease in the modern day domestic cat. Out of 200 cats, approximately 1-2 develop diabetes during their lifetime. In diabetes mellitus the blood glucose level of the cat is constantly too high. Feline diabetes is similar to type II diabetes mellitus in humans. The corner stones of treatment of diabetes are effective insulin treatment early on in the disease, diet and avoidance of obesity. With aggressive treatment early on combined with efficient monitoring, some cats go into remission and can be managed without insulin later on.
Insulin is a hormone secreted by the beta cells of the pancreas. It increases the movement of glucose in the blood into cells of the body, which in turn decreases the amount of glucose in the blood. Insulin resistance occurs often early on in the disease: insulin is secreted by the pancreas, but it does not function properly in the body. This means that blood glucose levels remain high. Obesity, certain diseases (e.g. acromegaly and inflammatory conditions) as well as some medications (e.g. cortisone) are known to cause insulin resistance.
Due to insulin resistance blood glucose level is high, which leads the pancreatic beta cells to secrete even more insulin. If insulin resistance continues, the beta cells tire, and the production of insulin decreases or completely stops. Insulin production might normalize early on in the disease process if the factors causing insulin resistance are gotten under control. Lifelong treatment with insulin is needed if the destruction of pancreatic beta cells is complete. The avoidance of obesity is key to preventing diabetes. A diet high in protein and low in carbohydrates improves glucose balance and reduces insulin resistance.
Multiple risk factors besides obesity have been identified. These include increasing age, male gender and physical inactivity. Some breeds such as the Burmese cat are more at risk for development of diabetes. The typical diabetic patient is an overweight 11-13-year-old male cat who lives indoors.
Typical signs of diabetes are excessive drinking and urinating. The cat loses weight despite having a good appetite. The signs progress slowly, and it is often difficult to say exactly when they started. If left untreated, the disease leads to diabetic ketoacidosis, in which vomiting and extreme fatigue occur. Diabetic ketoacidosis is a life-threatening condition.
If diabetes is suspected a blood and urine sample are taken at the vet. The diagnosis is based on clinical signs combined with the laboratory results. Blood glucose in cats is affected by stress (caused by a visit to the vet for example), so just a slightly high blood glucose value does not necessarily mean the cat is diabetic. A high fructosamine value supports the diagnosis of diabetes, as it describes blood glucose levels from the past few weeks.
The goal of treatment is to keep blood glucose at a level where the signs of diabetes are nonexistent and the quality of life of the cat is good. Drinking and urinating are not excessive, and the cat is bright and alert. Too high and too low blood glucose levels are avoided. The primary goal in recently diagnosed diabetic cats should be remission, in which insulin is no longer needed after the initial treatment period. This often requires tight monitoring of blood glucose levels.
The management of diabetes requires a lot of commitment from the owner. Diabetes is treated by subcutaneous injections of insulin. Usually the cats tolerate the injections well, but repetitive injections combined with tight monitoring might cause stress. The type and dosage of insulin is determined by the treating veterinarian. Oral diabetes medications are often ineffective and are not considered a first-line treatment.
Home monitoring of blood glucose levels is an important part of the treatment, especially if aiming for remission. Portable blood glucose meters are easy to use. Blood glucose curves can be done to see how low the blood glucose level drops after injection of insulin and how long the effect of the injection lasts. In some cases urine dipstick tests can be used for detection of glucose in the urine, but this is not a reliable method of monitoring blood glucose levels on its own.
A diet with high protein and low carbohydrate helps keep blood glucose levels stable. Commercial diets for diabetic cats are available. Feeding of canned food instead of dry food is recommended because of the lower caloric density and ease of portion control.
The weight of the cat is monitored at home: obesity is avoided but fast weight loss might be indicative of poor control of the disease. Intentional weight loss needs to be slow and gradual. Moderate exercise is beneficial and improves weight control and general well-being. Playing and climbing should be encouraged. Changes in appetite, drinking and urinating need to be noted. When blood glucose levels are too high, the excess glucose is excreted in urine. Glucose pulls out a lot of water with it, which increases the amount of urine and thus the amount of water the cat needs to drink.
Visits to the veterinarian are frequent especially in the beginning of management of the diabetic cat. Blood glucose and fructosamine levels are monitored. Diabetes predisposes the cat to developing urinary tract infections and urine samples are controlled. Blood tests are checked for signs of other issues, because blood glucose balance is strongly affected by different inflammatory conditions as well as other diseases. Dental care is very important. If the disease is gotten well under control the frequency of veterinary visits can be decreased.
Hypoglycemia, low blood glucose, may occur rapidly and be life-threatening. Hypoglycemia may be due to an overdose of insulin due to insulin administration issues or if the pancreas has started secreting insulin and the cat is going into remission. Administration of insulin if the cat is not eating or is vomiting may also lead to hypoglycemia. Chronic hypoglycemia occurs when insulin is administered subcutaneously even though the pancreas has recovered and the production of insulin has begun. Hypoglycemia does not provoke hunger in cats, so the situation is not corrected by the cat eating on its own. The importance of blood glucose monitoring cannot be stressed enough.
Signs of hypoglycemia in cats may be very vague and variable and range from lethargy, ataxia and tremors to coma. Rapid treatment is required. If the clinical signs are mild, feeding a meal or sugar water/honey is suggested. In more severe cases, honey can be applied to mucous membranes of the cat before transportation to the veterinarian. Severe hypoglycemia requires treatment in-hospital with parenteral glucose.
Complications from hyperglycemia, high blood glucose, develop slower than those associated with hypoglycemia. Hyperglycemia occurs when there is a problem with the injection of insulin, the insulin does not function properly, the insulin dosage is not sufficient or something interferes with insulin function in the body. Diabetic ketoacidosis develops when blood glucose levels have been high for some time and the body starts to use free fatty acids for energy. This results in ketones accumulating in the body. Signs of diabetic ketoacidosis include vomiting, anorexia, excessive drinking and urinating, fatigue and sweet-smelling breath. The condition requires aggressive treatment in-hospital.
Neurological deficits may also be seen with chronic hyperglycemia. The most typical is plantigrade stance, in which the cat walks on the sole of the hindfeet and its heels touch the ground. Muscle atrophy in the hind limbs and difficulty jumping/climbing may be seen before plantigrade stance occurs.
The prognosis of diabetes is better if treatment is started early on. Cats are masters of hiding their illness, and routine veterinary visits and blood samples help with early detection of diabetes and other diseases. Prevention of obesity is essential in the prevention of diabetes and musculoskeletal diseases among others.
Diabetes is a severe disease and its treatment requires a lot of commitment from the owner. With proper management, diabetic cats can live many years of high quality cat life.
A while ago Kissapuu.com online shop made an inquiry for Finnish newsletter subscribers and FB followers asking their opinion “What features are essential in cat climbing and scratching tree?” Participants were asked to choose from 3 to 5 features that are essential when buying a cat tree. The options were following:
a) Looks & how well a cat tree fits to own interior decoration
b) Possibility to select materials of cat tree (wood, rope & felt)
c) Possibility to choose number of platforms and their place in the tree
d) Separate & maschine-washable sleeping pads of platforms
e) Durability, eco-friendliness & possibility to replace materials of worn parts (felt, rope)
g) Firmness of cat tree for cat climbing
h) Easiness of assembly
i) Possibility to change place of a cat tree (no permanent fastening)
j) Size of cat tree (how much floor space a tree occupies)
k) Multiple payment options in online shop (bank transfer, credit card, invoice or account)
l) Fast delivery
m) Anything else, what?
101 answers were received. When purchasing a cat climbing and scratching tree the most important features were considered to be the following (ranking from 1 to 5):
This feature was considered preeminent, 70 respondents mentioned this. 19 respondents of them ranked this characteristic as most important giving it position number 1. Overall, the firmness of a cat tree was considered very important, it received most nominations also on rankings 2 to 4.
This feature was considered the second most important (in total 44 answers). This characteristic was given first prize nominations as much as “possibility to choose materials of cat tree (wood, rope & felt).
28 respondents ranked this feature as number 1. However, the outlook criteria was considered less important than firmness and durability.
Price was the fourth most important feature = 33 respondents. This criterion got only one nomination for the 1. prize, but became third in ranking for positions 2. and 3. Equally important feature was considered “Separate & maschine-washable sleeping pads of platforms”.
This was the most important feature for altogether 10 respondents, but 30 mentioned it in general.
Subsequently important elements were: “possibility to change place of a cat tree (no permanent fastening) and “possibility to choose number of platforms and their place in the tree”. The least important was “fast delivery” meaning that cat homes can plan well in advance their purchases.
The results of this small survey confirmed our opinion of a good cat climbing and scratching tree. Kissapuu Cat Tree was born by our own need. We did not find a cat tree in the market we would have wanted to have in our living room. It is important for cat’s well-being that it is able to carry out species-specific activities, i.e. climb and manicure its nails. It is also of primary importance that the tree is firm and withstands bigger cats. At the same time a cat climbing and scratching tree can be a stylish interior decoration element and eye-catcher in your living room. Also a cat tree can be design, your cat’s elegant favourite place that withstands looks and time. Nowadays eco-friendliness is self-evident. Even a cat becomes fond of long-lasting furnitures. Cat is by nature wise friend of nature and environment.
Author: Veterinarian Mimma Aromaa
I work as a veterinarian at Kaarinan Eläinlääkäriasema Oy (Kaarina, Finland). In particular, I am interested in the internal diseases of cats and dogs, ie. vomiting, diarrhoea, and weight loss - sluggish and tired patients are a daily challenge for me. I specialize in extensive abdominal ultrasound examinations. My two Burmese cats are my daily guide to the interesting soul landscape of cats.
Vomiting is one of the most common symptoms in cats. A common symptom means that vomiting is a symptom of the entire body, and therefore there may be a number of different causes in the background. Sometimes it can be difficult for the owner to distinguish between coughing and vomiting. Indeed, coughing suggestive of respiratory disease can be misinterpreted as, for example, vomiting or trying to clear the throat from hair. Vomiting is defined as a reflex series in which the pumping motion of the abdominal muscles and diaphragm causes the contents of the stomach to be emptied by pressure. During coughing, on the other hand, the cat often stretches its neck long and "pushes" air or mucus out of the airways without pumping movement from the stomach or emptying the stomach contents into the mouth. It is also normal for cats to empty their stomach by vomiting due to undigested material such as feathers and bones of prey animals. In this case, the cat may aid in the vomiting reflex by eating grass, for example. But how do you know when vomiting is worrying?
All cat owners are familiar with the fact that cats groom their fur daily by licking and plucking it. In this case, it is normal that small amounts of hair end up in the stomach and intestines. In a balanced situation, the hair passes through with the stool, and only rarely does a cat have to vomit and empty the stomach of hairballs or suffer from constipation due to hair. The balance may be shaken if abnormal amounts of hair start to move into the intestine or because of a problem with the digestive tract and the hair does not pass through the intestine normally. Especially in long-haired cats, the amount of hair entering the intestine at the time of hair loss can increase significantly. Also certain hair types may result in continuously increasing amounts of hair entering the intestine. Skin problems or excessive grooming due to pain or behavioral disorders, may also increase the amount of hair entering the gut. It is therefore always important to consider whether there is a predisposing cause for hair vomiting that could be addressed and treated, rather than just treating the hairball vomiting symptomatically. However, if persistent episodes of excessive hair loss, vomiting, or constipation have not been shown to have a clear predisposing cause, or if the cause cannot be remedied, measures preventing the hair from accumulating in the cat's stomach and intestines should be taken. Increased drinking can promote normal hair passage through the digestive tract; for example, the cat may be offered tuna or honey flavored water, or the number of water bowls can be increased by placing them around the apartment if the cat likes to drink in unusual places. To improve bowel function, a high fibre diet is recommended. Choose high fibre food or introduce fibre supplements. Cat malt, paraffin oil or lactulose can be used for short periods or as a treatment when needed, as in continuous use they may interfere with normal gut function and food absorption. Regular grooming and finishing by wiping with eg. a damp cloth is recommended to remove small loose hairs from the fur, otherwise they may end up in the cat’s mouth.
Nausea, loss of appetite and vomiting can be caused by a variety of reasons that may not involve hairballs at all. Food allergy, inappropriate food or contaminated food can trigger symptoms. Many medicines, unsuitable plants or intake of other substances known to be toxic or harmful can also cause symptoms. The digestive tract may also have an internal parasitic infection, chronic inflammation, foreign objects or a tumor. Foreign objects, such as pieces of a plastic bag or soft parts from a toy, are likely to cause only temporary vomiting, but eating a cord or eating an ear plug can cause intestinal obstruction, which can have very serious consequences. Also many visceral diseases such as diabetes, hyperthyroidism, kidney, liver, biliary or pancreatic problems commonly lead to nausea, fasting and vomiting. Only on rare occasions do dental diseases cause vomiting or loss of appetite in cats, even though a food dropping, drooling cat that has abandoned kibbles and switched to wet food alone, may seem to have something wrong in the mouth. In such cases the behaviour is commonly due to nausea, and the fact that wet food does not cause uncomfort and nausea in the same extent as dry food.
The age, lifestyle and history of your cat will help determine what causes may be more likely than others. For example internal infections, inappropriate food, foreign objects, and consumption of inappropriate matters are likely causes of symptoms in young cats. A young cat from a large cattery may have symptoms due to a parasitic infection, or may carry asymptomatic giardia, which may infect older cats in the family. An outdoor cat, and especially a predatory cat, is also more susceptible to internal infections or intoxication. An indoor cat that has lived alone or in the same herd for a long time without newcomers is highly unlikely to have an internal parasitic infection. In older cats, symptoms caused by endocrine disorders and tumors are much more common.
Symptoms can be acute, ie. lasting less than a week, or chronic with symptoms for weeks, months, or even years. The severity of the symptoms can range from a mild to a very serious collapse in the general condition, where the cat does not eat, is dehydrated, in pain and even feverish. Acute and rapidly transient symptoms of vomiting in an alert and pain free cat does not require immediate examination or treatment, but if eating does not return to normal within a few days, the vomiting is abrupt and the cat cannot hold his food, is in pain or very weak, it is good to seek medical advice immediately. Most commonly, chronic wavy symptoms such as gradually creeping vomiting, on / off loss of appetite, and weight loss occur in chronic endocrine disorder, where examination and treatment is not acute. However, even in these cases, it is a good idea to consult a veterinarian in a timely manner, which often makes it much easier to treat the underlying cause or get it under control. Acute syndromes causing acute symptoms, on the other hand, are often severe and require immediate medical attention and treatment.
Reviewing the cat's history with the owner, reviewing the severity and duration of the symptoms, and a thorough veterinary examination are the most important steps for choosing the correct follow-up exam. Unnecessary tests are also avoided. In acute cases with mild symptoms, dietary changes or symptomatic treatment may be recommended without an examination, as the underlying cause for symptoms is likely to be self-healing. Acute severe and chronic symptoms often require blood tests. Occasionally, urine and/or fecal samples are also advisable. For example, X-rays can assess the size and shape of organs and the possibility of a foreign object. Often a well-performed ultrasound examination is more informative for a vomiting cat than an X-ray. This enables an examination of the structure and shape of the internal organs, indicates the possibility of a tumor or degeneration in tissues, and show the thickness, structure and contents of the mucous membrane of the stomach and intestines, as well as possible obstructions and inflammation in the pancreas and bile ducts, bladder contents, or whether there may be free fluid in the abdomen or reactive lymph nodes. The aim is to combine the various exam results to find the cause of the symptoms and then discuss treatment options and prognosis with the owner.
The article was originally published in Finnish Siberian Cats Association, issue 1/2019.
Andrea Harvey & Séverine Tasker. BSAVA Manual of Feline Practice A Foundation Manual. BSAVA 2014.
Jacquie Rand. Problem-based Feline Medicine. 1.p. Saunders, Toronto 2006.
Susan E. Little. August’s Consultations in Feline Internal Medicine vol 7. Elsevier 2016.
Etienne Côté. Clinical Veterinary Advisor Dogs and Cats. 3 ed. Elsevier, Missouri 2015
A pet going missing, running away or being stolen are a pet owner’s worst nightmares. A registered microchip is a vital tool in the case of missing pets. When found, the pet is scanned using a reader. If a microchip is detected, the furry friend can be returned home soon. Pets must always have a microchip when they are entered into a show or taken abroad.
An ID chip, or microchip, is a capsule roughly the size of a grain of rice (measuring approx. Ø1.4*8.5 mm), containing electronic parts. A layer covering the capsule/ampule enables the chip to attach itself to tissue, forming a connective tissue capsule. The chip is inserted in place using a needle-like, sterile tool designed specifically for this purpose. Microchips come in a variety of sizes. The same chips work with different animals, such as cats, dogs or rabbits. A kitten can be chipped young, at 8–12 weeks, for instance alongside vaccination. The procedure itself is similar to vaccination; the chip is inserted under the skin on the back of the animal’s neck. The chip stays under the skin as long as the veterinarian ensures the chip does not come out with the needle, or that the chip is not placed on the cat’s fur (as can happen with long-haired cats).
Inserting the chip might be slightly painful and the insertion point might bleed a little. On the other hand, some pets might not notice anything. However, microchipping an aggressive cat may be difficult, or downright impossible, meaning that it is safer to perform chipping during e.g. castration. In x-rays, the chip will be visible as a capsule the size of a grain of rice. Sometimes the chip can be felt through the cat's skin. When performed by an experienced, trained expert, microchipping should be harmless for a pet.
The chip’s functionality is confirmed by checking that it works by responding with a number sequence. The 15-digit sequence is a sort of identification code for the pet. However, it is not the same as the pet’s registration number, but rather a number sequence coded by the chip’s manufacturer, compliant with international standards. The sequence can only be read with a specifically designed reader, which transmits a low radio frequency that activates the chip, which itself has no energy source.
Since the chip can move under the pet’s skin, it is recommended to scan from head to tail, in case the chip is not found at the back of the neck. The ID chip should last for the animal’s entire lifetime, although they can break due to injuries to the chip location or surgical procedures. A veterinarian should check the microchip at every visit to confirm the chip’s and the owner’s information, including right of ownership.
A chip is useless without registration, since the chip itself only contains a number sequence. After ID-marking an animal, it must be immediately registered in a database. This prevents possible misuse in cases such as disappearances. During registration, the chip number is given and the owner's contact information is attached to it. It is recommended to register a pet in several databases, improving the chance and speed of finding the owner. Animal shelters etc. can access certain databases at any time of day, whereas others are only accessible during business hours.
Paperwork filled out during registration should be stored with your health card or registration book together with one chip number sticker. Other stickers should be stored in case you need to apply for a passport for your pet. Information about which register the chip is entered should also be stored in the same place. This information is important, since correctness of the register information is always the pet owner's responsibility.
There are four registers in use in Finland, which anyone can check to see if an animal’s chip has been registered. Information in the register about pet owners can only be accessed by register administrators, who decide to whom and under what terms should information about owners be disclosed. The chip number must be treated like one’s own personal ID, since the number can verify that the pet in question is yours when picking it up from the person who found it.
There is also an ongoing project in Finland called Miljoona Mikrosirua (A Million Microchips), whose goal is to provide affordable microchipping and registration with the help of business partners. The chips have been donated by municipalities, companies and organizations, among others. Microchipping events are organized in Finland at least bi-monthly. No reservations are needed and payments are done in cash. Microchipping specialists trained by veterinarians perform the insertion and the information is saved into a register.
Text by Julianna Hautoniemi
Originally published in Sacred Birmans in Finland association’s member magazine, issue 1/2019.