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Diagnosis of diabetes is usually pretty straightforward, using blood and urine tests. Most cats will require insulin, but there is a small minority of cats who can be managed with a diet change. It can take several weeks for a cat to become regulated on insulin, and close contact with your veterinarian is imperative. It's also important to have a veterinarian who is familiar with current recommendations for diabetic cats, as taking care of a diabetic cat is much different than taking care of a diabetic dog. Once regulated, cats usually have insulin injections twice daily.
Just like with people, cats with diabetes can have complications, including kidney disease, poor healing, and neurologic problems. If left untreated, or if it's not recognized soon enough, cats can develop a toxic condition called Ketoacidosis, which can be difficult to treat and can actually lead to death.
We are starting to see more cats who have what we consider pre-diabetes. These cats are found to have high normal blood sugar levels on routine screens, and have other risk factors, such as being overweight, or eating a high carbohydrate diet. Have a serious talk with your vet about what you can do to prevent your cat from becoming a full-blown diabetic cat.
As always, if you have any questions or concerns, contact your veterinarian. You know your cat better than anyone, and if you think something may be wrong, you're probably right!