Diabetic Neuropathy in Cats: Vet Explained Signs, Cause & Treatment

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Diabetes is one of the more common diseases found in senior cats; in fact, it is their second most commonly diagnosed endocrine disorder¹. Unfortunately, signs of diabetes can be relatively non-specific in that several other conditions may also share these signs, making early diagnosis without regular testing tricky. Of these signs to watch for, though, signs of diabetic neuropathy, which are present in about 8% of diabetic cats, are usually less subtle and easier for pet parents to identify².

Diabetic neuropathy is the bilateral, progressive loss of sensation, reflexes, and strength of the limbs due to nerve damage from chronically high blood sugar. While nerves all throughout the body can be affected, in cats specifically, the hindlimbs are almost always affected first, creating a recognizable group of signs to monitor for.

The 10 Signs of Diabetic Neuropathy in Cats

Plantigrade Stance – cat’s hocks are lower to the ground than usual when walking or standing, often to the point of touching the ground
Progressive Paraparesis – slowly worsening weakness of both hindlimbs
Ataxia – unsteady, swinging, or wobbly gait
Decreased Spinal Reflexes – weak withdrawal of hind limbs when tested
Proprioceptive Deficits – lack of awareness of where limbs are in space, leading to foot-dragging and crossing when walking, failure to correct a foot that is placed or flipped wrong side down
Hyporeflexia – weak or lacking patellar reflexes (knee-jerk reflex)
Muscle Atrophy – loss of hindlimb muscle mass over time
Hyperesthesia – signs of pain or other sensitivity of the feet. May appear as over-grooming, chewing, limping, or muscle twitches
Changes in Activity Level – decreased willingness or ability to jump, climb, scratch, and play
Palmigrade Stance – less common than plantigrade stance, this is when progression is severe enough that the cat’s wrists also drop

The Cause of Diabetic Neuropathy in Cats

Persistently high blood sugars, potentially with glucose also seen in the urine, lead to toxic accumulations of sugar in the cells associated with nerves, which can degrade and kill them over time. As many as 90% of diabetic cats may show signs of affected nerves in specialized tests, and the longer their blood sugars remain high, the more likely they are to develop neurological signs³.

What Are Other Signs of Diabetic Neuropathy?

While all nerves have the potential to be affected, different species will have different susceptible nerves. While highly unlikely to be seen on their own, other neurological symptoms that may be seen concurrently in cats could be facial paralysis, changes to pupil dilation, eye position changes, or breathing difficulties.

It is also highly likely that your cat will exhibit some other signs of diabetes beyond those of diabetic neuropathy.

vet doctor using stethoscope on cat — Image Credit: bmf-foto.de, Shutterstock

Diabetes in Cats

Cats (and all vertebrates except most fish) have an organ located near the beginning of the intestinal tract called the pancreas. The pancreas has two jobs, to produce enzymes to help digest food, and to produce a hormone called insulin, which controls how much glucose, or sugar, enters cells across the body, which is then used for energy.

What we know as diabetes is actually diabetes mellitus, a condition in which an animal fails to move glucose into cells, and it instead builds up levels in the blood.

Diabetes mellitus is most often broken down into two categories:

Type 1 Diabetes – a complete lack of the cells in the pancreas that produce insulin, therefore meaning there is little to no insulin in the body, leading to high blood sugar levels
Type 2 Diabetes – a lack of production of insulin, or a lack of efficacy or response to the insulin by the body (insulin resistance), leading to high blood sugar levels

Does the Type of Diabetes Matter?

Type 2 diabetes is by far the most common type in cats. Factors such as weight, genetics, and activity level can be related to a cat’s risk of developing diabetes in their lifetime. Control of diet, weight, and blood sugars can, therefore, also allow a diabetic cat to potentially go into remission, where their cells become more appropriately sensitive to insulin again.

While this is relevant for strategies to help a cat with persistently high blood sugar levels respond to treatment, the type does not appear to affect diabetic neuropathy directly in cats.

a Norwegian forest cat eating from a bowl — Image Credit: Astrid Gast, Shutterstock

Common Causes of Diabetes in Cats

Weight, genetics, and activity levels are the largest risk factors contributors to diabetes in cats.
Burmese, Norwegian Forest cats, and Tonkinese breeds can be more susceptible to developing diabetes.
Diabetes is present in males far more often than in females.
On average more than half of diabetic cats are overweight and obese cats are about 3.9 times more likely to develop diabetes than their ideal body weight counterparts.
Diabetes is more common in middle-aged to senior cats.
Diabetes can also be transiently present in pregnant cats or secondary to some cancers.

Diagnosis of Diabetes

Blood glucose readings over 400 mg/dL
Fructosamine levels over 400 µmol/L
Glucose in the urine
History of relevant symptoms

Treatment of Diabetes in Cats

Currently, there are several different ways to approach treating diabetes, which is great for our feline patients who can vary widely in their cooperation with receiving medications and treatments, eating special diets, or having their blood sugars screened regularly.

Here are the common facets of treatment below:

Insulin – Insulin therapy consists of daily injections under the skin of supplemental insulin. This includes regularly scheduled checks of a cat’s blood sugars to assess the dosage of the insulin, as advised by their veterinarian. Glucose checks can be done with blood samples but also with continuous glucose monitors now, which are typically far less stressful and allow for more accurate at-home readings (stress raises blood glucose levels).
Diet – High protein, low carbohydrate diets with an additional focus on weight loss can help your cat control their diabetes or even lead to remission entirely. Canned or wet diets are preferred over dry as they usually have a better ratio of proteins to carbohydrates and better support hydration.

Some cats will not tolerate insulin injections or regular diagnostics, but some can go into remission from diet changes, even just changes to wet food alone, so it is always best to try as much as possible to treat. In cases that are late to diagnosis or do not respond well to treatment, even if doing everything, diabetic neuropathy is more common.

cat getting insulin injection — Image by: Dina da, Shutterstock

Frequently Ask Questions: Diabetic Neuropathy in Cats

How Do I Know If My Cat Has Diabetic Neuropathy?

If a cat is diagnosed with diabetes and has any of the above signs, that is enough for a diagnosis. In special cases, biopsies of the muscles and nerves can be done to confirm a diagnosis.

Can Diabetic Neuropathy be Treated in Cats?

Unfortunately, while diabetic neuropathy can be indirectly treated, it cannot be cured. Quick identification of the problem and reduction of blood glucose levels can sometimes improve symptoms marginally, but weakness and muscle loss are usually permanent. The goal is to slow the progression of the condition and maintain the quality of life of the cat.

Conclusion

Persistently high blood sugars due to diabetes can cause toxic damage to cats' nerves, known as diabetic neuropathy. Signs often include hindlimb weakness, instability, muscle loss, and a characteristic plantigrade stance. While there is no cure, control of diabetes can ease symptoms and slow progression.

If you have a cat exhibiting any of the signs of diabetes listed above or have a diabetic cat with signs of diabetic neuropathy, please speak to your veterinarian, as early identification of either condition can significantly improve outcomes for your pet.