Section 2: Recognizing DM in Cats

While diabetes can occur in cats of any age, most present at age 4 or older. One study showed that 82% of diabetic cats were >7 yr old and 50% of diabetic cats were between 10 and 15 yr of age.¹ Male cats constitute a greater proportion of the diabetic population than female cats, and it is unclear if neutering plays a role in diabetes development.² Most affected cats are mixed breed (i.e., domestic shorthair or domestic longhair); however, Burmese cats have been shown to have an increased risk of diabetes.^3,4

Feline diabetes risk factors include:^5,6

• Obesity (factors that contribute to obesity include neutering, high-carbohydrate diets, and lack of environmental enrichment)
• Sedentary lifestyle
• Middle age and older life stages
• Male

Diabetic cats are often obese, and clients may report that their cats exhibit signs of PU, PD, PP, weight loss, and lethargy. Hindlimb weakness (plantigrade stance) and an unkempt hair coat may be noted on physical examination.⁷ However, the physical examination can be relatively normal, and gradual progression of PU, PD, or weight loss may be initially subtle and go unnoticed by the pet caregiver during early stages of disease onset. To catch these early signs, it is important to assess cats’ body condition and muscle condition scores at every visit and ensure that team members consistently use the same condition scales (i.e., 5-point versus 9-point scales). See the AAHA Nutrition and Weight Management Guidelines at aaha.org for detailed information on body and muscle condition scoring systems. The presence of diabetic ketoacidosis (DKA) along with concurrent disease processes can also affect the examination findings (see Section 12, Diabetic Ketoacidosis).⁸

In cats with clinical signs of DM, BG exceeds the renal reabsorption threshold for glucose (~250–300 mg/dL) and cats will be hyperglycemic and glucosuric. However, these findings are not specific for DM. Evaluate the results of a CBC, blood chemistry, urinalysis, TT4, and blood pressure measurements in cats with clinical signs that suggest DM. Elevated BG in the absence of clinical signs may reflect transient hyperglycemia due to stress.⁹ If stress hyperglycemia can be ruled out in an asymptomatic hyperglycemic cat, consider monitoring the patient as one at risk for developing DM (Section 5, Recognizing and Managing Cats at Risk of DM). Mild to moderate persistent hyperglycemia (BG <300 mg/dL) without glucosuria suggests subclinical diabetes,^10,11 so it would be prudent to identify and address possible causes of IR (see Box, Section 1, Causes of Insulin Resistance in Cats). Definitively diagnosing feline DM requires evidence of sustained hyperglycemia (see Section 3, Diagnosing
DM in Cats).

The task force referenced Project ALIVE for standardized DM terminology and to define criteria used for DM diagnosis. For more information on Project ALIVE, see https://www.esve.org/alive/search.aspx.

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