Section 5: Recognizing and Managing Cats at Risk for DM

This section concerns management of cats that are found to have intermittent or sustained mild to moderate hyperglycemia unrelated to stress, and who do not display clinical signs of DM. These cats should be considered “at-risk” for developing clinical DM or to have subclinical diabetes. Although some portion of at-risk cats may eventually develop clinical DM, they do not require diabetic therapy until a clinical DM diagnosis is confirmed. Transient stress hyperglycemia is a well-recognized phenomenon that occurs in normal cats but is also observed in at-risk cats. Hyperglycemia due to stress can be severe but is generally <250 mg/dl and by definition is a transient elevation. Glucosuria may occur with severe stress hyperglycemia; ketonuria is not expected. Stress hyperglycemia is confirmed in patients by demonstrating resolution of hyperglycemia after the cat is removed from the stressful situation. The recommended follow-up for stress hyperglycemia is to reassess BG and check urine for glucosuria and ketonuria several days after the stressful event (ideally blood and urine samples are obtained at home). In select cases, it may be necessary to place a CGM or measure a serum fructosamine concentration.

Obtain a thorough history for at-risk patients and evaluate for concurrent diseases or medications that may result in insulin resistance. Take steps to prevent at-risk patients from becoming overtly diabetic. Avoid administering medications such as corticosteroids or progestins.¹ Treat any concurrent diseases (e.g., obesity, chronic inflammatory conditions). Lifestyle and dietary modifications are logical first steps, with the goals of optimizing body weight, minimizing postprandial hyperglycemia, and controlling calorie, protein, carbohydrate, and fat intake. Replace food treats with playtime to encourage movement and potentially contribute to weight loss. Environmental enrichment may facilitate weight loss and reduce obesity,² therefore reducing cats’ risk of developing diabetes.^3,4

Monitor at-risk patients regularly. Pet caregivers should weigh at home monthly and be advised to note any changes in water consumption or urine output. Tailor BG and urinalysis monitoring frequency to individual patient indications. CGMs may be helpful to determine which cats need further diagnostic evaluation. In overweight patients, such monitoring reveals whether hyperglycemia corrects with weight reduction. Monitoring is also essential to identify patients whose hyperglycemia does not resolve with previously mentioned interventions, or who develop overt DM.

At present, it is difficult to accurately predict whether or not an at-risk patient will progress to develop overt DM. Progression may be more likely when the patient has a risk factor that cannot be addressed or reversed with treatment. There is currently no known strategy to prevent DM. At this time, there is no evidence to support the use of SGLT2 inhibitor drugs, insulin, or any other anti-diabetic medication for at-risk or subclinical patients.

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