Health & Medical

I cried in the car park after the diagnosis. Not because it was hopeless, but because the vet had said the words twice a day, every day, for the rest of his life, and I had immediately decided I was not the sort of person who could inject a cat.

Three weeks later I was doing it in eight seconds while he ate. Eleven-year-old ginger tom named Sherbet, diabetic since 2022, and he has no idea anything unusual happens to him.

Feline diabetes usually shows up in overweight, middle-aged and older cats, males more than females. The pancreas either does not make enough insulin or the body has stopped responding to it, so glucose stays in the blood instead of getting into cells. The signs are drinking a lot, weeing a lot, eating well while losing weight, and eventually a flat, sick cat with a strange sweet smell to the breath. Sherbet was emptying the water bowl twice a day and I had put it down to the summer.

Diagnosis is a blood glucose plus a marker called fructosamine, which shows the average over a couple of weeks, because a single high reading can just mean a stressed cat at the vet. Stress hyperglycaemia in cats is real and significant, so nobody should start insulin on one number.

The injections are the easy part

This is what nobody believes until they do it. The needle is tiny, thinner than a hair, going into loose skin over the shoulders or flank. Cats have very little sensation there. Sherbet has never once reacted, and the two times I have caught a nerve and he twitched, I gave him a bit of chicken and he forgot immediately.

The routine that works: prepare the syringe first, roll the insulin pen gently rather than shaking it, put the food down, inject while he eats. Rotate the site each time so one patch of skin does not toughen. Twelve hours apart, as close to the same times as you can manage, which for me is seven and seven and has quietly reorganised my social life.

The genuinely difficult part is not the needle. It is that insulin without food is dangerous. If a diabetic cat refuses his meal, the dose gets reduced or skipped and you phone the vet, because a full dose into a cat who has not eaten drops blood sugar too far. Know the signs of hypoglycaemia before you ever need them: wobbliness, confusion, glazed eyes, twitching, and in the worst case a seizure. The emergency response is honey or glucose syrup rubbed onto the gums, then straight to a vet. I keep a tube of glucose gel in the kitchen drawer and have used it once in four years.

Food does most of the work. Cats are obligate carnivores and a high-protein, low-carbohydrate diet is now standard advice, which in practice usually means wet food rather than dry, because dry kibble carries carbohydrate simply to hold its shape. Sherbet went onto a veterinary low-carb wet diet and his insulin requirement dropped by about a third within two months. Two measured meals rather than free grazing, timed with the injections.

Weight loss matters enormously and it has to be slow. An obese diabetic cat who loses weight sensibly sometimes stops needing insulin altogether, because feline diabetes can go into remission in a way that human type one never does. The window for that is best in the first few months after diagnosis with tight control, which is the strongest argument for taking this seriously early rather than muddling through.

Monitoring at home changed everything for us. I was doing blood spots from the ear with a lancet, which he tolerated but neither of us enjoyed, and then we moved to a continuous glucose sensor stuck to his flank that reads to a phone. It stays on about a fortnight. It is not cheap and not every cat keeps it on, but seeing the curve rather than single points meant the vet could adjust the dose properly instead of guessing between four-hourly readings at the clinic.

Urine strips are the cheap version and better than nothing, though they lag behind what is happening in the blood.

Things to watch for long term. Diabetic neuropathy makes the back legs weak and produces a flat-footed, hocks-down walk, and it often improves with good glucose control. Urinary infections are more common and easy to miss. Dental disease pushes glucose up. And the one to know cold is diabetic ketoacidosis, which is a cat who is vomiting, lethargic, not eating, breathing oddly, with sweet breath. That is an emergency the same night, not the morning.

Boarding and holidays need planning. My cattery charges extra for injections and needed a written schedule and a vet letter, and I found that out three days before a flight.

Four years on it costs me maybe forty pounds a month and sixteen seconds a day. He is asleep on the radiator shelf as I write this, fatter than the vet would like, entirely unaware of any of it.