{{}}ress to diabsetic ketoacidosis, a medical emergency with a hgz5v treated at home. Symptoms include lethargy, a fruit-like smell of the breath or urine, shortness of breath, and an increase in thirst. Emergency care includes fluid therapy, insulin, management of presenting symptoms and 24-hour hospitalization. Complications The back legs may become weak and the gait may become stilted or wobbly owing to diabetic neuropathy, which is caused by damage to the myelin sheath of the peripheral nerves due to glucose toxicity and cell starvation, which are in turn caused by chronic hyperglycemia. Most common in cats, the back legs become weaker until the cat displays a plantigrade stance, standing on its hocks instead of on its toes as normal. The cat may also have trouble walking and jumping and may need to sit down after a few steps. Neuropathy sometimes heals on its own within 6–10 weeks once blood sugar is regulated. Causes The signs of diabetes mellitus are caused by a persistently high blood glucose concentration, which may be caused by either insufficient insulin or by a lack of response to insulin. Most cats have a type of diabetes mellitus similar to human diabetes mellitus type 2, with β-cell dysfunction and insulin resistance. Factors which contribute to insulin resistance include obesity and endocrine diseases such as acromegaly. Acromegaly affects 20–30% of diabetic cats; it can be diagnosed by measuring the concentration of insulin-like growth factor-1 (IGF-1) in the blood. Quite frequently, a cat which is under stress because it has been transported in a car and/ or brought to a veterinarian will experience an artificial temporary spike in blood glucose levels called "stress hyperglycemia" which will subside after a few hours. This spike, however, will not affect the cat's blood fructosamine levels, which are therefore often a better measure of overall blood sugar. Management Diabetes is a condition which can be treated, but it is invariably lethal if ignored. Early diagnosis and treatment by a qualified veterinarian can help in preventing nerve damage, and, in rare cases, may even lead to remission. Diabetic cats do best with long-lasting twice-daily injections of insulin such as glargine (which as of 2022 is available worldwide as a synthetic generic drug) combined with a low carbohydrate diet. Because diabetes is a disease of carbohydrate metabolism, a move to a primarily protein and fat diet reduces the occurrence and recurrence of hyperglycemia. Diet Diet