Issue 29.3 - May 2020

Liver and pancreatic disease

Other articles from the previous issue

Feeding behavior in cats

Feeding behavior in cats

We all need to eat to survive. But for humans, eating can be much more than a simple task to be undertaken on a daily basis; our mealtimes allow us to rest and relax, and perhaps catch up with friends or family as we enjoy our food. But from a cat’s point of view, eating is not quite the same, as Jon Bowen explains.

Breed and diet-based disease in dogs

Breed and diet-based disease in dogs

When faced with a dog that has a severe problem it can be easy at times to overlook the significance that breed plays in susceptibility to a disease. Giacomo Biagi offers a brief overview of some common breed-related problems where diet can play a major role.

Nutrition for the diabetic cat

Diabetes mellitus can have far-reaching effects on the body’s metabolism; Dr. Vandendriessche offers a common-sense approach to the patient and reviews how careful dietary choice, along with lifestyle changes, can help achieve optimal control of the problem.

Introduction

Diabetes mellitus is probably the most common feline endocrinopathy, with type 2 diabetes being much more frequently encountered than type 1, being diagnosed in up to 95% of diabetic cats. Each new feline patient that presents with diabetes is a challenge for both the veterinarian and the nutritionist, because it requires us to take into account many different factors with the ultimate goal of achieving euglycemia and improving both the patient’s quality of life and life expectancy.

Not only does the correct medical treatment – with a long-acting insulin – need to be initiated, the nutrition and the overall management of the feline patient must be adjusted in order to both reduce (and, ideally, eventually eliminate the need for) insulin dosage and enable the cat to reach its ideal body weight. All these changes have to be implemented in agreement with the owner’s abilities and the cat’s preferences; otherwise compliance with the proposed alterations is unlikely to be successful. As both a practicing veterinarian and a board-certified nutritionist, I hope to supply you with hints, gained from my experiences throughout the years dealing with such patients, in a way that will help you to tackle such cases with more confidence in the future.

Obesity and diet

Many cats with type 2 diabetes have a mild to severe form of obesity (Figure 1). It is therefore necessary to change their diet to a food which is specifically designed to make them lose weight; however, it is essential that weight loss is achieved in a controlled manner, so that the cat remains healthy, yet the diet chosen must limit the glycemic load. Such a diet is typically low in energy, high in fiber and protein, and low in soluble carbohydrate; it should also be enriched with anti-oxidants and L-carnitine. A diet that is low in energy will allow the owner to feed a larger volume of food, which will help to maintain satiety between meals; this is aided by the increased amount of insoluble fiber in the diet. The soluble fiber fraction in the food will slow the uptake of nutrients, thus helping to control the glycemic load. The high-protein content is necessary to avoid muscle breakdown due to the caloric restriction in the food; this has a synergistic effect with increased activity levels (see below) which together helps improve lean body mass development. Anti-oxidants will counteract the negative effects of obesity-related chronic inflammation, and L-carnitine will facilitate the use of fat – rather than glucose – as an energy source by the cells.

The choice between a dry and a wet diet should be made in consultation with the owner, and should take into account the cat’s preferences and habits prior to the diagnosis. In general, wet diets are often better at achieving satiety; so moisturizing kibble may be a good option if a cat does not like pouches or pates. Another advantage of moisturizing kibble or using wet food is that urinary health may improve, as recurrent cystitis is a common comorbidity in diabetic and/or obese cats. However the most important thing is to ensure that the cat has a consistent, predictable food intake (which for some cats might only be achievable with a dry diet).

The amount to be fed should be calculated using an estimation of the cat’s ideal bodyweight, and as a starting point the aim should be to supply 293 kJ (= 70 kcal) per kg metabolic bodyweight: ideally the cat should lose between 0.5 and 2% of its body weight each week once on the new diet. Weight assessment should therefore be done during each follow-up consultation (Figure 2) and adjustments to the ration made in accordance with the weight loss.

Figure 1. Most cats with type 2 diabetes are at least mildly obese, and it is essential to ensure that they are offered a diet which is specifically designed to help them lose weight.
© Shutterstock
Figure 2. All diabetic cats should be subject to regular weight checks, and the diet adjusted if necessary.
© Shutterstock

Feeding regime

Figure 3. An automatic feeder allows a cat to be fed multiple small meals throughout the day, which will mimic its natural feeding behavior.
© Shutterstock

Meal supervision is also a crucial factor in managing these patients, and feeding should be tailored around the insulin injections. In practice this means that two larger meals (2x 30% of daily amount) should be fed at 12-hour intervals, offered before the insulin injections, with the remainder of the feed given between times in smaller portions.

When the patient will only eat wet diets, the owner’s time schedule will dictate feeding times, as the food should be given fresh, but if the cat will eat kibble, investing in one (or more) automatic feeders is a must. These will enable the cat to be fed multiple small meals throughout the day, thus mimicking its natural behavior (Figure 3). The advantage of having more than one automatic feeder is that the cat has to exercise more – i.e., it has to move between the feeding stations. Importantly, however, it is essential to alter the schedule each day, so that the cat does not know which feeder will open at which time. Failure to do so means that the cat will simply wait in front of the feeder it knows will open next.

Activity stimulation

Veerle Vandendriessche“The choice between a dry or a wet diet should be made in consultation with the owner, and should take into account the cat’s preferences and habits prior to the diagnosis of diabetes.”Veerle Vandendriessche

As mentioned before, it is necessary to stimulate physical activity in these patients, and in many cases a cat’s activity levels can be increased by simply altering the way in which it is fed. Some of the options available include:

  • Advising the owner not to feed their pet on the floor but rather to provide the food on a raised area, so that the cat has to jump up to feed (Figure 4). This should however take into account the cat’s abilities to jump; this should be discussed with the owner and, if necessary, the place chosen to feed the cat may need to be altered as the cat loses weight. The more weight the patient loses, the harder it should be made for the cat to reach its food.
  • Encourage the owner to distribute the food throughout the cat’s living area, rather than just supplying it in a single bowl. This can easily be done with both kibble and wet diets.
  • Suggest that the owner uses feeding toys so that the cat has to expend more energy getting to its food (Figure 5).
  • Enrich the cat’s living environment in any way possible; this will encourage the cat to explore its surroundings and will provide both mental and physical stimulation. (Figure 6).
Figure 4. Owner should provide the food on a raised area so that the cat has to jump to feed. This will help the cat expend more energy getting to its food.
© Shutterstock
Figure 5. Feeding toys not only ensure that a cat expends energy in obtaining its food, they also provide mental stimulation.
© Ingrid Johnson

Figure 6. Diabetic cats should be encouraged to maintain their activity levels; both physical activity and loss of body fat can contribute to remission of the diabetic state. By enriching a cat’s environment with things such as boxes, tunnels and climbing frames, the cat will be encouraged to explore its surroundings.
© Shutterstock

Conclusion

In summary, each cat with type 2 diabetes should have its feeding regime reviewed and, if necessary, be prescribed a diet which is specifically designed to achieve healthy weight loss, facilitate glycemic control and reduce the time required to reach euglycemia. Along with simple alterations to the cat’s lifestyle and environment, this will improve the cat’s quality of life and aid in delivering the desired weight loss.

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