03/27/2026
It’s purrrrfect!
Automated insulin delivery (AID) systems may mark the beginning of a new era in feline diabetes management.
The present report describes the use of this technology in a diabetic cat, resulting in remission. The system consisted of a pump to deliver insulin, a continuous glucose monitoring system (CGMS), and an algorithm controlled by a smartphone application—functioning similarly to a physiologic pancreas by dynamically adjusting insulin delivery based on real-time glucose measurements.
An 11-year-old neutered male domestic shorthair presented with persistent hyperglycemia (395 mg/dL) and glucosuria, with the usual symptoms of diabetes mellitus.
Initial management was unsuccessful. From Day 0–5, protamine zinc insulin (2 IU q12h) resulted in poor glycemic control, followed by insulin glargine (2.5 IU q12h) from Day 5–7, which also failed to achieve adequate regulation. Continuous glucose monitoring demonstrated hyperglycemia approximately 75% of the time, with a mean glucose concentration of ~290 mg/dL.
Given persistent dysregulation, an automated insulin delivery system was initiated with the following approach:
• Estimated total daily insulin requirement: ~7 IU/day
• Reduced with safety factor → ~4.9 IU/day
• Target glucose: ~120 mg/dL
• Continuous titration based on real-time glucose trends
Within 24 hours, glycemic control improved markedly:
• ~99% time in the target range (70–180 mg/dL)
• Mean glucose ~122 mg/dL
• No hypoglycemic episodes
By Day 3, glucose concentrations remained entirely within the target range, with progressive reduction in insulin requirements. Over the following two weeks, glycemic control remained stable (up to 97% time in range), accompanied by resolution of clinical signs.
Insulin therapy was discontinued by Day 33. The cat maintained euglycemia thereafter, achieving diabetic remission that persisted at 2-year follow-up.
The authors propose that the rapid and sustained normalization of glucose concentrations may have reduced glucotoxicity, thereby allowing recovery of the remaining pool of viable pancreatic β-cells and increasing the likelihood of remission.
This approach reduces reliance on multiple daily injections, improves quality of life for both patient and owner, and may facilitate remission through precise, continuous glycemic control.
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