Should I Euthanize My Cat With Diabetes?

By Dr Daisy May MRCVS BVSc (Distinction), Veterinary Surgeon

If your cat has just been diagnosed with diabetes, you’re going to have a million questions, and I’ll level with you: this blog post isn’t here to answer them all. This blog post, as the title suggests, focuses on answering just one: should I euthanize my cat with diabetes? 

This question is pertinent to owners of newly diagnosed diabetics, as well as to owners who have been struggling for a while to help a feline family member with diabetes, and may feel like they are getting nowhere.

There are articles out there that’ll tell you treating your diabetic cat will be a rewarding adventure, will deepen your bond, will be an exciting journey into what it truly means to care for a pet. These articles come from a good place, but seem to have been written by individuals wearing rose tinted spectacles.

Likewise there are articles out there that will condemn you-the-pet-owner for even considering euthanasia, especially at the point of diagnosis, rather than giving it all you’ve got. These articles rather unfairly imply negligence, and that if you loved your cat you’d magically summon up the money, time, practical and emotional wherewithal to fix your cat (if you love him/her).

In reality, life is never clear cut and things aren’t that simple. In reality, there is no right or wrong, and I’m not here to make you feel better or worse about making the decision to euthanize your diabetic cat. 

I’m just here to provide insight, as a veterinary doctor; as a cat owner; and as a fellow human being, as well as to provide some relevant factual information and statistics to help you make a more informed decision. 

Disclaimer: Please bear in mind that this article isn’t a substitute for taking your diabetic cat to the vet, discussing your concerns and making a definitive plan of action with your pet’s own personal veterinarian. Rather, this article aims to highlight key considerations that should be taken into account when it comes to making this difficult decision, and to help prepare you practically and emotionally for what to expect. 

That way, you can enter into that discussion with several important questions already mentally answered, as well as a mental checklist of the point you still want to cover. It’s also helpful to have a firm, clear outcome that you would ideally like to achieve, as well as some understanding of whether or not this is likely to be realistic and achievable. 

And by the way… to avoid any confusion, please be aware that throughout this article when I refer to diabetes, I mean diabetes mellitus.

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Feline Diabetes: Key Facts

• It’s estimated that between 1 in 100 and 1 in 400 cats suffer from diabetes mellitus[1].
• One in ten owners make the decision to euthanize their cat at the point of diagnosis with diabetes, and as many as 17% of owners choose to euthanize within a few weeks of the diagnosis being made [2].
• Despite the above statistic, with careful management the outlook for feline diabetes is usually good. Note that I say with careful management. Note too, that I say usually good. 
• 90% of cats with diabetes mellitus are “insulin resistant”, meaning that their “brand” diabetes is most similar to type 2 (insulin resistant) diabetes in humans.
• Obese cats are four times more likely to develop diabetes compared to their non-obese counterparts.
• Male cats are more likely to develop diabetes than females, and the disease typically affects cats over 7 years of age. 
• Your vet will diagnose diabetes through a combination of blood and urine tests. Sometimes, more than one blood test will be needed to confirm diabetes. 
• The mainstays of treatment are injectable insulin and diet.

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Diabetic Remission: Key Facts

• Just like human type 2 diabetes, sometimes feline diabetes goes into remission. 
• Remission means a period of time during which your previously-diagnosed cat is no longer showing any signs of having diabetes, and isn’t requiring any treatment.
• The more quickly the condition is diagnosed, and the more aggressively and strictly it’s treated, the higher the chances of remission being achieved. 
• Having checked out a few different studies and scientific data sets, I can report that the remission rates given for feline diabetes vary a LOT from source to source! 
• As few as 17%, or as many as 89% of cats may be able to achieve remission. In my personal experience, the true figure probably is around 30%, which agrees with this large scale Swedish from 2023[2].
• When remission is achieved, there’s no way of knowing how long this will last: it could be weeks, months or years.

Key point: before making the decision to euthanize, cat owners should consider the fact that about 1 in 3 diabetic cats will achieve remission.

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My Cat Has Diabetes: What Should I Expect?

1. Expect to give your cat insulin twice a day, every day, potentially (but not necessarily) forever. 

In reality for the vast majority of cats injectable insulin needs to be given twice daily to achieve good control of the diabetes; once isn’t enough. Yes, that may mean organising your life around your cat a little bit more. Only you can decide if that’s possible, and only you can iron out the practicalities of this. Consider if friends, family members or neighbours can be brought on board to help if there is the odd injection that you won’t be able to manage yourself. By the way, most boarding catteries and many pet sitters will have experience and be able to cater for diabetic cats.

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2. You ideally need to be proactive in monitoring your cat’s blood sugar at home; but don’t panic if you can’t. 

It’s helpful to become familiar with how to carry out spot blood glucose checks at home, and how to check your cat’s urine for ketones using dipsticks. Your vet can talk you through how to do these things, and the equipment  you will need. It’s simpler than you might think, I promise, and quickly becomes an easy habit. 

However, many owners obviously choose not to monitor their cat’s blood glucose themselves at home, for whatever reason, and frankly as far as I’m concerned that’s fine too. Home monitoring is not an absolute requirement. What is an absolute requirement is keeping an eye out for any signs of major problems, and turning up for regular vet checks. 

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3. There are absolutely financial considerations that you need to take into account. 

Insulin, needles and syringes will be an ongoing cost. Vet visits will be an ongoing cost: I tend to recommend that diabetic feline patients see me for a check up every 3 months once stable. And if your cat were to develop diabetic ketoacidosis, a serious potential complication of diabetes, then a stay in a veterinary hospital is going to be required, probably for a period of 3-7 days. Obviously this too can be expensive, and these things need to be planned for. 

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4. If at all possible, you should ask your vet to organise a specialist abdominal ultrasound scan or CT scan for your cat. 

An important aspect of feline diabetes which is sometimes overlooked is that there can sometimes be an underlying cause, such as pancreatitis or even pancreatic cancer. Pancreatitis in cats can be subtle, chronic (long-term) and difficult to detect, but can cause significant suffering if untreated. Studies have shown that pancreatitis may be present in as many as 60% of diabetic cats[1].

Furthermore, between 8-19% of diabetic cats euthanized following referral for specialist veterinary management were found at post mortem to have pancreatic cancer[1]. As such, if your cat isn’t responding well to their treatment plan, further investigations to rule this out become especially important. 

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Feline Diabetes: Reasons To Consider Euthanasia

The following is not an exhaustive list. Your cat, your circumstances and your influencing factors will absolutely be unique to you. As such, this list is intended simply to guide, and to provide an overview of the things I (as a veterinarian) have encountered as reasons to seriously consider euthanasia in a diabetic cat. 

If your reason isn’t on the list, it doesn’t mean I don’t think it’s valid. Likewise, just because your reason is on the list, doesn’t necessarily mean that euthanasia is your only option. Above all, I urge you to discuss your situation openly and honestly with your veterinarian: they are there to help you, not to judge you.

1. Failure to achieve stabilisation despite everybody’s best efforts: ideally, this means seeing your vet every 2-4 weeks for a period of at least 12 weeks. 
   
2. The presence of co-existing conditions that make it harder to achieve stabilisation of diabetes: these may be permanent eg acromegaly and Cushings, or treatable eg dental or urinary disease. 
   
3. The presence of other serious co-existing medical conditions such as cancer, hyperthyroidism or chronic kidney disease. Not every cat with co-existing conditions will need to be euthanized. With dedicated owners who are prepared to put in the work with frequent vet visits, as well as the availability of sufficient finances, even some very complex medical cases may be manageable. But as always, I’ll be honest: the more “other things” your cat has going on, the more the odds are stacked against you, and the harder it will be to achieve medical stability and a good quality of life. 
   
4. The presence of co-existing conditions that require steroid treatment, for example, certain types of dermatitis/chronic itchy skin that is not responsive to non-steroid medications. This is because it is very difficult to achieve adequate control of a cat’s diabetes whilst they are taking steroid medication. So, this situation can sometimes be a bit of a stalemate. 
   
5. Your cat has developed diabetic ketoacidosis (DKA) and is clinically unwell (eg, lethargic, vomiting, dehydrated) and – for whatever reason – appropriate veterinary treatment isn’t possible or you’ve decided against it. 
   
6. Your cat has lost their sight due to diabetic cataracts, and is distressed by this fact or struggling to adjust and – for whatever reason – cataract surgery isn’t an option. 
   
7. You can’t cope practically, emotionally or financially with owning a diabetic cat and rehoming isn’t a valid option. And by the way, just because this factor is at the bottom of the list, doesn’t mean I think it’s the least important, nor that I think it’s a “wrong” thing to do or makes you a bad person at all. However: I would urge any pet owner who is making the difficult decision to euthanize for a reason that is personal to them rather than relating to their pet, to strongly consider whether they are in an appropriate place to commit to getting another pet.
   
   I will never, never  judge you for euthanizing your diabetic cat because you aren’t in a place where you can look after them. Your circumstances may have changed since you first got your pet, or maybe you simply didn’t foresee that this could happen. I understand that life is complex. However, I will absofuckinglutely judge you if you euthanize your diabetic cat and immediately get a new kitten without first ensuring that you now have a solid plan in place and are prepared to look after him or her through sickness and health.
   
   Ultimately, owning a pet is a luxury; it is not anybody’s God given right. 

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I hope that this guide has helped, and please feel free to reach out with any questions in the comments section. Whilst your cat’s personal veterinarian is ultimately the best possible source of information relating specifically to your pet, if you have a question chances are another reader is also thinking it.

Vet Love,

Daisy x

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Reference List

1. Gottlieb, S. and Rand, J. (2018) ‘Managing feline diabetes: current perspectives’, Veterinary Medicine (Auckland), 9, pp.33-42. Available at: Managing feline diabetes: current perspectives – PMC (nih.gov) (Accessed 25 December 2023).
   
2. Rothlin-Zachrisson, N., Ohlund, M., Rocklinsberg, H. and Strom Holst, B. (2023) ‘Survival, remission, and quality of life in diabetic cats’, Journal of Veterinary Internal Medicine, 37(1), pp. 58-69. Available at: Survival, remission, and quality of life in diabetic cats – PMC (nih.gov) (Accessed 25 December 2023).