Section 11: Client Education

Be transparent, supportive, and empathetic with clients when discussing the commitment needed to manage their pet’s DM and emphasize that successful control is achievable but sometimes takes weeks or months. Give clients adequate access to veterinary team members trained to answer their questions and troubleshoot common problems. Provide written material for reference when the veterinary team is unavailable. Feature content that answers frequently asked questions, describes what to watch for at home, and explains how to respond to changes in their cat’s condition. For help generating written instructions, see the Diabetic Pet Discharge Template at https://www.aaha.org/resources/2018-aaha-diabetes-management-guideline-for-dogs-and-cats/diabetic-discharge-instructions/.

Explain that DM remission can occur in cats who receive insulin or an SGLT2 inhibitor. Emphasize that although achieving remission is a great goal, it is not the main focus as they monitor and care for their cats at home. Describe that remission typically happens when the cause of insulin resistance resolves (e.g., weight loss in an obese cat, diet modifications, stopping corticosteroids) and often occurs in the first 3-6 months after starting treatment.

Key Client Education Points for  Clients with Diabetic Cats

SGLT2 Inhibitor Monitoring and Administration

1. Explain that SGLT2 inhibitors are not insulin. Familiarize the client with safe and effective use of an SGLT2 inhibitor, including expected benefits, possible complications (including EDKA), required monitoring and follow-up. Inform the client about any specific concerns about the use of an SGLT2 inhibitor in their cat.
2. Advise clients to closely monitor cats during the first 2 wk of therapy because DKA is more likely to occur within this time. Educate clients about signs of DKA.¹
   1. Emphasize that the cat needs veterinary evaluation if the client notes any decrease in appetite or if the cat is not feeling well in general.
3. Instruct clients to tell the veterinary team that their cat has diabetes and is receiving an SGLT2 inhibitor. This is especially important in the emergency setting where a complete medical record may not be available.
4. Discuss how and when to dose the drug and explain what to do if a dose is missed, if the cat is uninterested in food and misses a meal, or if the cat vomits before or after administration.
   1. If the client misses an SGLT2 inhibitor dose, instruct them to administer the dose as soon as remembered if relatively close to their normal administration time, otherwise pick up dosing again at the next scheduled treatment time the following day.
   2. If the cat vomits after dosing, instruct the client to redose if vomiting occurred within 30 min of administration. If it occurred after 30 min, instruct the client that it is not necessary to redose. If vomiting persists, clients should be instructed to contact the veterinary clinic.
   3. If the cat is on an SGLT2 inhibitor and is uninterested in food for more than 24 hr or seems unwell, ketosis may be a concern. Check
      BHB and seek veterinary assistance.

Insulin Effects, Handling, Storage, and Administration

1. Explain to clients how insulin works and its effects on BG.
2. Discuss what to do if the cat does not eat a full meal or vomits before or after insulin administration. See Frequently Asked Questions at aaha.org/diabetes-management-cats for more information.
3. Teach clients about proper handling and storage of the specific type of prescribed insulin, including the following points as appropriate:
   1. Gently roll but do not shake the vial when using glargine U-100, PZI, glargine U-300, or insulin degludec.
   2. If using porcine insulin zinc suspension (Vetsulin), shake the vial to obtain a homogeneous, uniformly milky suspension.
   3. Do not freeze insulin or expose it to heat. Avoid leaving insulin in environments prone to temperature extremes (e.g., a parked car) and wherever prolonged exposure to direct sunlight or freezing temperatures may occur.
   4. Refrigerate insulin to maintain a consistent environmental temperature and allow extended use of each vial. When insulin is refrigerated and handled carefully, the task force is comfortable with clients continuing to use insulin beyond the manufacturer recommended in-use duration (28–56 days for most insulin types). Preservative-containing insulin vials in use for 6 mo were not shown to be at increased risk of bacterial contamination.² If there are any questions about insulin efficacy or a cat’s DM clinical signs recur despite fully compliant insulin therapy, the task force recommends replacing the insulin vial.
   5. Clients can wipe the vial stopper with alcohol before inserting the syringe needle, but this was not associated with improved prevention of bacterial contamination over 6 mo of vial use.³
   6. If the insulin ever appears flocculent, discolored, or exhibits consistency changes, it should be replaced immediately.
4. Explain the types of insulin syringes and which one to use.
   1. Always use a U-40 insulin syringe with U-40 insulin and a U-100 insulin syringe with U-100 insulin.
   2. 0.3- and 0.5-mL insulin syringes or insulin pens best facilitate accurate dosing, especially in cats receiving <5 units per dose.⁴ (Veterinarians need to evaluate whether the needles in the insulin pens are long enough for each patient [i.e., 10-12 mm].)
   3. Syringes with 0.5-unit increment hashmarks or commercially available syringe magnifiers are also available to allow more accurate dosing than visual estimation using a standard syringe.
   4. Syringes are for single use.
   5. Do not use “short” needles. Use standard 29-gauge, half-inch needles.
5. Explain insulin pen use.
   1. Some insulins, such as glargine U-300 and degludec U-200, must be administered with an insulin pen.
   2. Insulin pen cartridges contain mixing beads and are typically held extended and waved up and down to mix the insulin before use.
   3. Use a new needle for each injection and prime the insulin pen needle before administration.
   4. Check the manufacturer-recommended injection time to ensure full dose is administered.
   5. Dose adjustments vary based on the type of insulin pen and range from 1/2-U to 2-U increments.
6. Demonstrate proper insulin dose measurement and administration technique.
   1. Use sterile saline to allow the client to practice giving injections until they feel comfortable.
7. Teach clients to recognize hypoglycemia and take action if it occurs.
   1. Signs include lethargy, sleepiness, strange behaviors, abnormal gait, weakness, tremors, and seizures.
   2. If the cat is conscious, clients should feed a high-carbohydrate meal (e.g., rice, bread, pasta, add corn syrup to regular diet).
   3. If the cat is poorly responsive or has tremors, clients should be prepared to rub 1 teaspoon of corn syrup onto the cat’s gums using a cotton-tipped applicator or syringe (some experts use a dose of up to 0.25 mL/kg). The client should never be instructed
      to place their fingers into a hypoglycemic patient’s mouth.
   4. Advise the client of the risk of aspiration in an obtunded animal. Feed the cat if the cat responds within 5 min. Take the pet to a veterinarian.
   5. Empower clients to decrease or skip an insulin dose and seek urgent veterinary assistance if signs of hypoglycemia are noted, but warn them to never increase the insulin dose or frequency of administration without clear instructions from their veterinarian.

Lifestyle Change Expectations

1. Review the schedule commitment required for administering the recommended treatment.
   1. Insulin is often given twice daily.
      1. Newer insulins may allow less frequent injections for some patients.
   2. SGLT2 inhibitors are given once daily.
2.  Explain that insulin needs change over time, which may require more frequent veterinary visits.
3. Discuss home monitoring aids and their role in assisting with monitoring, and that these do not replace the need for in-hospital veterinary
   evaluations.
4. Discuss client experience and impacts on quality of life (e.g., caregiver attachment, fatigue, caregiver grief when pet passes).

Home Monitoring Options

1. CGMs are useful tools for clients and veterinary professionals. These allow 24 hr continuous monitoring and can give the health care team more detailed information on glucose control. Although they are labeled for 15-day use in humans, they rarely last this long in cats. However, even 2–3 days’ worth of data is useful.
2. Clients may prefer to use a glucometer. Use only a veterinary-calibrated PBGM, such as the AlphaTrak 3.
3. Cats on insulin who may be approaching remission can be monitored for glucosuria using glucose strips or glucose-detecting litter (e.g., Royal Canin Glucodetect by BluCare (https://blucarelab.com/products/).
4. In cats, one of the parameters reported to be a useful and practical indicator of clinical DM control is the amount of water consumed over 24 hr.⁵ Microchip-linked water monitors, like Felaqua Connect (surepetcare.com/en-us/felaqua-connect) and others, can be useful at-home tools for clients to document water consumption.
5. Clients are often happy with the level of clinical DM control, despite not having laboratory evidence of tight glycemic control, emphasizing that the long-term goal of DM treatment is to eliminate clinical signs.⁶

Additional client resources are available in the AAHA Diabetes Management Guidelines resource center at aaha.org/diabetesmanagement-cats.

The 2026 AAHA Diabetes Management Guidelines for Cats are generously supported by Adapet Medical, Boehringer Ingelheim, Dechra, and Merck Animal Health.