FDA has approved two new drugs to treat diabetes mellitus (high blood sugar) in cats. Both drugs are given orally (by mouth) once daily.
Bexacat (bexagliflozin tablets) and Senvelgo (velagliflozin oral solution) (liquid) have certain requirements to make sure the drugs are used safely. These new drugs are different from insulin shots, which is the traditional treatment for diabetes mellitus in cats. Your veterinarian can decide whether Bexacat, Senvelgo, or insulin shots is the right choice for your diabetic cat. Before we discuss these new drugs, though, let’s learn a little more about diabetes mellitus, or diabetes, in cats.
What Is diabetes mellitus?
First, let’s talk about blood sugar (often called blood glucose) and how it’s normally controlled in your cat’s body. When your cat eats, her body breaks the food down into different molecules. One of those molecules is glucose, a type of sugar. Glucose is an important source of energy for cells in her body. The pancreas is the part of the body that makes insulin, a hormone that helps control the amount of glucose in your cat’s blood. It does this by helping the cells use glucose when they need energy. It also tells the liver to store some of that glucose, so it can release some later if blood glucose levels get too low.
Sometimes, though, blood glucose levels rise higher than they should. If your cat’s pancreas doesn’t make enough insulin (insulin dependent diabetes) or your cat doesn’t respond to the insulin it makes properly (insulin resistant diabetes), the cells can’t use glucose in the blood for energy. The glucose stays in the blood and the cells don’t get the energy they need.
What are the signs of diabetes in cats?
If your cat has diabetes, you may notice that she is:
- drinking more
- urinating more
- hungrier than normal
- losing weight even though she’s eating the same amount or more food than before
- walking or standing in an unusual way—with her hocks (ankles) touching or nearly touching the ground
Your cat may also show signs of urinary tract infection. Urinary tract infections are common in cats with diabetes because bacteria like the sugary environment caused by the high glucose in the urine. Signs of urinary tract infection in cats can include blood in their urine, straining to urinate, pain when urinating, and urinating small amounts more often.
How is diabetes in cats diagnosed?
Your veterinarian will ask you questions about your cat’s behavior and examine her to look for obvious changes like weight loss and dehydration. If your veterinarian suspects diabetes, he or she will recommend blood and urine tests to see if your cat has high blood glucose and glucose in her urine. Diabetes tends to occur in older cats that may also have other health problems, so it’s important to get the full picture of your cat’s health.
How is diabetes in cats treated?
Diabetes is a disease that usually requires lifelong treatment and regular monitoring. Treatment may include:
- feeding your cat as recommended by your veterinarian,
- encouraging weight loss if she is overweight (being overweight can predispose your cat to diabetes),
- insulin shots (insulin dependent diabetic cats do not make enough insulin and need insulin shots),
- Bexacat (bexagliflozin tablets) or Senvelgo (velagliflozin oral solution) (liquid) sodium-glucose cotransporter 2 (SGLT2) inhibitors. (Diabetic cats that make some insulin, but don’t respond to it like they should, may be able to use SGLT2 inhibitors to treat their diabetes.)
Now that you know more about diabetes mellitus, and how it’s diagnosed and treated in cats, let’s talk a little bit about Bexacat and Senvelgo, the two new FDA-approved drugs to treat diabetes in cats.
How do Bexacat and Senvelgo work?
Your veterinarian may have prescribed Bexacat or Senvelgo for your diabetic cat. Both drugs belong to a new class of diabetes drugs called SGLT2 inhibitors. SGLT2 inhibitors are not insulin. SGLT2 inhibitors do not help a diabetic cat’s cells use glucose for energy. Instead, SGLT2 inhibitor drugs lower your cat’s blood glucose by excreting glucose through the kidneys.
What are the side effects of Bexacat and Senvelgo?
Both Bexacat and Senvelgo have important safety concerns. Your veterinarian will carefully screen your cat before starting either drug. While she is taking Bexacat or Senvelgo, your veterinarian will frequently monitor her overall health, blood glucose, and other blood and urine tests, to make sure her blood glucose is responding as expected. The check-ups and tests will help your veterinarian quickly recognize and appropriately treat any serious side effects.
Common side effects seen with Bexacat and Senvelgo include
- diarrhea or loose stools
- not eating as much or no interest in food
- lack of energy, hiding, or decreased grooming
- continued weight loss
- increased drinking
- increased urination
- ketonuria (a buildup of ketones in the urine)
Serious side effects, such as diabetic ketoacidosis and pancreatitis, can happen with or without warning, even if your veterinarian appropriately screened and closely monitored your cat. Serious side effects can happen even if your cat has had stable blood glucose levels while taking the drug. This is why careful monitoring is so important no matter how long your cat has been on Bexacat or Senvelgo.
What is diabetic ketoacidosis:
Diabetic ketoacidosis is a life-threatening condition that can happen with diabetes. When the cells can’t use glucose for energy, they can become so starved that the body starts to break down fat for energy, creating molecules called ketones. Too many ketones can cause your cat’s blood to become very acidic, leading to “ketoacidosis”. Signs of ketoacidosis can include
- bad (worse than normal) or sweet-smelling breath
- not wanting to eat or drink
- acting more quiet than normal
- vomiting and/or diarrhea
- trouble breathing
- collapse and coma (this is a sign of severe diabetic ketoacidosis)
Diabetic ketoacidosis may happen more often during the first week of treatment with Bexacat or Senvelgo, but it can occur at any time. Cats that have previously been given insulin shots should not take Bexacat or Senvelgo, as these cats have a higher risk of developing diabetic ketoacidosis.
What is pancreatitis?
Pancreatitis is inflammation of the pancreas, which can sometimes be serious and life-threatening. Signs of pancreatitis can include:
- a painful belly
- not wanting to eat or drink
- lack of energy
- hiding or acting more quiet than normal
- vomiting and/or diarrhea
Pancreatitis is diagnosed based on your cat’s signs, physical exam findings, blood test results, and X-ray or ultrasound findings.
How are Bexacat and Senvelgo given to cats?
Unlike insulin shots, Bexacat, a flavored tablet, and Senvelgo, a liquid solution, are given by mouth once a day. The drugs should be given at approximately the same time each day, with or without food, and regardless of the cat’s blood glucose level. If you forget to give Bexacat or Senvelgo to your cat, you should give a dose the same day, then continue giving the drug on your regular schedule. It’s extremely important that if your cat shows less interest in her food or she stops eating, her activity level decreases, she starts vomiting or having diarrhea, or she has weakness or difficulty walking, stop giving the drug and contact your veterinarian immediately.
Which cats CANNOT take Bexacat and Senvelgo?
Some cats can’t take Bexacat or Senvelgo:
- Cats that have been treated with insulin in the past or are currently on insulin.
- Cats that are lethargic (less energy than usual, laying around), dehydrated, or aren’t eating.
- Cats that have other health problems, especially disease of the kidneys, liver, or pancreas.
- Cats that have diabetic ketoacidosis.
- Cats that don’t meet the required weight for the drug.
Based on your cat’s medical history, overall health, and the results of blood and urine tests, your veterinarian can decide if Bexacat or Senvelgo is a good choice to treat her diabetes.
Bexacat and Senvelgo can be effective to treat diabetes mellitus but are not right for every diabetic cat. The drugs can be used to treat certain cats with diabetes that don’t require insulin shots. Your veterinarian knows your cat’s medical history and can guide you on the best treatment for her diabetes. With proper treatment and monitoring, you and your veterinarian can help her have more quality time at home with you.
Resources for You
- FDA Approves First Oral Treatment for Cats with Diabetes Mellitus
- Bexacat Client Information Sheet
- Bexacat Freedom of Information Summary
- Dear Veterinarian Letter advising veterinarians of important safety conditions associated with the use of Bexacat (bexagliflozin tablets) for improving glycemic control in certain cats with diabetes mellitus
- Senvelgo Client Information Sheet
- Senvelgo Freedom of Information Summary
- Dear Veterinarian Letter regarding important safety conditions associated with the use of Senvelgo (velagliflozin oral solution) for improving glycemic control in certain cats with diabetes mellitus