Section 4: Evaluating Newly Diagnosed Diabetic Cats

The task force recommends a full laboratory evaluation for every diabetic cat before selecting treatment (see Section 3, Box, Recommended Laboratory Tests). This includes a CBC; a chemistry panel with cholesterol, triglycerides, and electrolytes; a urinalysis (UA) with sediment examination; and a total T4 measurement if not done prior to diagnosis. Blood BHB should be measured in all newly diagnosed diabetic cats, as the results may affect treatment choices.¹ While not specific to DM, retroviral testing may be considered part of the minimum database for any sick feline patient evaluation.

Identify whether diabetic cats have complications associated with the disease (e.g., peripheral neuropathy) or concurrent problems often associated with the disease (e.g., pancreatitis). If the cat has signs of cystitis (i.e., dysuria, pollakiuria) and an active urine sediment, perform a quantitative urine culture and sensitivity, and then use the results to guide therapy.²

Also identify conditions that may interfere with the patient’s response to treatment (insulin-resistance-causing diseases such as obesity, pancreatitis, hyperthyroidism, renal disease, hypercortisolism, hypersomatotropism, and other risk factors such as the use of diabetogenic medications) so these can be addressed appropriately. As insulin is needed for insulin-like growth factor-1 (IGF-1) production in the body, IGF-1 concentrations may be unremarkable at DM diagnosis. However, if after 4-6 weeks of insulin treatment there is concern for IR or signs of hypersomatotropism, evaluating IGF-1 would be appropriate.³

Most newly diagnosed diabetic cats present with weight loss, but the magnitude of condition loss can vary. When a newly diagnosed diabetic cat presents with substantial weight loss (>15%), emaciated, or with cachexia or sarcopenia, evaluate for comorbidities such as pancreatitis, neoplasia, exocrine pancreatic insufficiency, hyperthyroidism, or chronic enteropathy. Depending on the cat’s specific history and clinical signs, consider performing additional diagnostics such as measuring feline pancreas-specific lipase immunoreactivity, serum folate and cobalamin, and serum trypsin-like immunoreactivity, along with abdominal and thoracic imaging. Diagnose and treat concurrent illnesses accordingly.⁴

Diabetic cats who exhibit substantial clinical compromise such as hyporexia, vomiting, and dehydration may have DKA. Documenting a high anion gap metabolic acidosis (e.g., low bicarbonate, low pH, +/- normal to low chloride at presentation) along with ketonuria or blood BHB >2.4 mmol/L confirms DKA (see Section 12, Diabetic Ketoacidosis in Cats).

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