# Diabetes and Incontinence in Cats: Why Urination Changes Diabetes can cause incontinence in cats because high blood sugar spills into the urine and pulls large amounts of water with it, so the bladder fills faster than your cat can manage. The problem is usually a sign of poor blood sugar control, though a urinary tract infection or another condition can look similar. This article is educational and is not a substitute for veterinary diagnosis or treatment. ## Quick Answer - Uncontrolled diabetes makes a cat produce far more urine than normal, which can lead to accidents outside the litter box even in a well-behaved cat [1]. - The main clue is volume. Diabetic cats with high blood sugar urinate large amounts often, while a cat with a urinary blockage or infection may strain and produce little [1][2]. - A urinary tract infection is common in diabetic cats and can cause the same accidents, so testing matters. - Good blood sugar control is the most reliable way to reduce the excessive urination and the accidents that follow. - Track how much your cat drinks, how often it urinates, and any accidents, then share those notes with your veterinarian. ## What Is Happening in a Diabetic Cat's Body Diabetes mellitus is a chronic disorder of carbohydrate metabolism caused by a relative or absolute lack of insulin [2]. Insulin moves sugar from the bloodstream into the cells that need it for energy. When insulin is missing or the body stops responding to it, sugar builds up in the blood instead. In Type I diabetes, blood glucose rises because the body makes too little insulin. In Type II diabetes, glucose rises because the cells do not respond properly to insulin. In both types, the cells cannot get the fuel they need even though there is plenty of sugar in the blood [1]. That high blood sugar is what drives the urination. The kidneys can only hold onto so much glucose. Once blood sugar climbs past that point, sugar spills into the urine. The sugar in the urine pulls extra water along with it, so your cat produces a large volume of urine, loses water, and gets thirsty to make up for it [1]. This is why feline diabetes polyuria (excessive urine production) and heavy drinking tend to show up together. Incontinence in cats with diabetes is often not true loss of bladder control. It is overflow. The bladder fills so quickly that your cat cannot get to the box in time, or the urge is simply too strong to hold. ## Signs Owners Notice The earliest signs of diabetes are usually increased thirst and increased urination [1]. Owners often notice the litter box needs scooping far more often, or the clumps are much larger than before. Other signs include: - Drinking from unusual places, such as the sink, toilet, or water glasses - Peeing outside the litter box, on floors, beds, or laundry - Weight loss despite a good or increased appetite - Dull coat, low energy, or less jumping and playing - Weakness in the back legs, which can be a sign of diabetic neuropathy [3] If your cat is also dropping weight quickly, it helps to know that diabetes is not the only cause. Thyroid disease and kidney disease can look similar. This guide on [why a cat may lose weight rapidly](/knowledge/veterinary-medicine/symptom-guides/why-is-my-cat-losing-weight-rapidly-hyperthyroidism-diabetes-ckd) walks through the differences. ### Accidents Outside the Litter Box A diabetic cat peeing outside the litter box is one of the most common reasons owners call the clinic. The cause is usually one of three things: 1. High blood sugar is producing too much urine. 2. A urinary tract infection is irritating the bladder. 3. Something else is making the box unpleasant, such as pain, arthritis, or a dirty box. Because these can overlap, the accidents alone cannot tell you which one is happening. That is a job for your veterinarian. ## Causes and Risk Factors The most important risk factors for diabetes in cats include obesity, increasing age, physical inactivity, male gender, and the use of glucocorticoids (steroids) to treat other illnesses such as feline asthma [1]. Some breeds, including Burmese cats in certain countries, appear to be at higher risk, though this may not hold true in the United States [1]. Obesity deserves special attention because it links directly to insulin resistance. In overweight diabetic cats, caloric restriction with a suitable diet is a real part of treatment, not an afterthought [4]. Steroids can push a cat into diabetes. One report described a cat that developed excessive urination and thirst within a week of receiving a long-acting steroid injection for itching [5]. If your cat is on steroids for another condition, your veterinarian will weigh that risk against the benefit. Less common causes can also drive urination changes. Cushing's syndrome, a disorder of excess cortisol, has been reported alongside diabetes in cats and can make both conditions harder to control [6]. Your veterinarian may look for it if your cat's diabetes is stubborn or if other signs, such as a poor coat, are present. ## How Incontinence and Urination Problems Are Diagnosed Diagnosis starts with the history you provide and a physical exam. Your veterinarian will want to know how much your cat drinks, how often it urinates, and whether accidents have increased. Testing usually includes: - Blood glucose to confirm persistent high blood sugar - Urine testing to look for glucose and to check for infection - Fructosamine, a marker that can help separate true diabetes from stress-related high blood sugar [2] Fructosamine is useful in cats because a stressful vet visit alone can raise blood glucose. A single high reading is not enough to diagnose diabetes [2]. If a urinary tract infection is suspected, your veterinarian may send urine for culture. Diabetic cats have sugar in their urine, which can encourage bacterial growth, so infections are a common complication. ### Telling Poor Regulation From a UTI | Feature | Poor blood sugar control | Urinary tract infection | |---|---|---| | Urine volume | Large amounts, often | Variable, sometimes small amounts | | Frequency | Very frequent, large puddles | Frequent, often small puddles | | Straining | Uncommon | Common | | Blood in urine | Uncommon | Possible | | Drinking | Increased | May be normal or increased | | Response to insulin change | Improves as glucose improves | Needs antibiotic treatment | This table is a guide, not a diagnosis. A cat can have both problems at once, and only testing can sort it out. ### When Urination Changes Are an Emergency A cat that strains to urinate and produces little or nothing may have a blockage, which is life threatening and needs emergency care right away. This is different from the large-volume urination of diabetes. If your cat is crying in the box, pacing, or repeatedly squatting with no result, treat it as an emergency. This article on [a cat straining to pee](/knowledge/veterinary-medicine/behavior/cat-straining-to-pee) explains the signs. ## Treatment Options Treatment for feline diabetes centers on insulin and diet [2]. Your veterinarian will calculate the insulin dose from your cat's weight, current blood sugar, and overall health. Never adjust the dose on your own. Diet matters. A therapeutic diabetic diet, combined with measured portions, supports better glucose control. In overweight cats, a planned calorie reduction targeting about 2% body weight loss per week improved outcomes in a randomized trial of 72 cats [4]. Some cats are treated with SGLT2 inhibitors instead of insulin. One case report described a cat that achieved diabetic remission after treatment with velagliflozin, though the drug was stopped because of diarrhea that did not improve with other measures [5]. These medications are not right for every cat, and your veterinarian will decide if one fits yours. If a urinary tract infection is present, it needs its own treatment. Controlling blood sugar alone will not clear an infection. ### Monitoring at Home Home monitoring makes a real difference. The 2026 AAHA Diabetes Management Guidelines for Cats cover at-home glucose monitoring devices and how to use them, along with insulin options, diet, and activity recommendations [7]. Ask your veterinarian which method suits your cat and your schedule. If your cat is on insulin glargine, this guide on [insulin glargine for cats and glucose curves](/knowledge/veterinary-medicine/calculators-clinical-tools/insulin-glargine-for-cats-feline-diabetes-dose-and-glucose-curve) explains how curves are used to fine-tune dosing. ## Recovery, Outlook, and Long-Term Management Many cats do well with treatment. Successful control that eases clinical signs and avoids low blood sugar is achievable in most cats, and remission is possible [7]. Remission means the cat no longer needs insulin, at least for a time. The outlook depends on consistency. Missed insulin doses, free-feeding, and skipped checkups all show up as rising blood sugar and returning accidents. Some complications are reversible with better control. One report described two diabetic cats that developed signs of congestive heart failure, and both improved once their blood sugar was stabilized. One cat had a recurrence during a period of poor control, then improved again when control was tightened [8]. This is a reminder that blood sugar affects more than the bladder. Sadly, not every cat gets the chance. About 10% of cats with diabetes are euthanized at diagnosis, and another 10% within the first year, even though diabetes is treatable [9]. Cost and worry about lifestyle changes are common reasons. If finances are a concern, tell your veterinarian early. There are often options. ### What to Track and Report Keep simple notes and bring them to every visit: - How much water your cat drinks each day - How many urine clumps or how much urine you remove from the box - Any accidents, with the time and location - Appetite, weight, and energy level - Any straining, crying, or blood in the urine - Insulin dose times and any missed doses These notes help your veterinarian tell poor regulation from an infection or another problem. ## Prevention You cannot prevent every case of diabetes, but you can lower the risk. Keeping your cat at a healthy weight is the single most useful step, since obesity is a leading risk factor [1]. Encourage daily play and movement, because physical inactivity also raises risk [1]. Feed measured meals instead of free-feeding, and ask your veterinarian for a target weight and body condition score. If your cat needs steroids for another condition, ask about the lowest effective dose and about monitoring blood sugar. For cats already diagnosed, prevention shifts to preventing complications. Keep every checkup, follow the monitoring plan, and act quickly when urination changes. If you notice increased thirst and urination in any cat, this guide on [excessive thirst and urination in cats](/knowledge/veterinary-medicine/digestive-and-urinary-care/cat-excessive-thirst-urination) can help you decide how soon to call. ## Limitations and When to Contact a Veterinarian This article covers general patterns. Your cat's case needs its own veterinarian, who can examine your cat, run tests, and adjust treatment. Contact your veterinarian the same day if: - Your cat is drinking and urinating far more than usual - Accidents outside the box have started or increased - You see blood in the urine, or your cat cries while urinating - Your cat is vomiting, not eating, or very tired Go to an emergency clinic now if: - Your cat strains to urinate and produces little or no urine - Your cat is crying, pacing, or repeatedly squatting with no result - Your cat is weak, wobbly, or unresponsive - Your cat is breathing hard or open-mouthed A urinary blockage can become fatal within hours, so do not wait. Call your veterinarian for a routine visit if: - Your cat's diabetes is stable but accidents have crept back - You are struggling with insulin timing, diet, or home monitoring - You want help setting up a tracking system ## Frequently Asked Questions ### Why does my diabetic cat pee outside the litter box? High blood sugar spills into the urine and pulls extra water with it, so the bladder fills faster than your cat can manage [1]. A urinary tract infection can cause the same behavior, so testing is the only way to know which is happening. Once blood sugar is better controlled, most accidents improve. ### Can incontinence in cats with diabetes be cured? The accidents usually improve or stop once blood sugar is well controlled, and some cats even reach remission and no longer need insulin [7]. True cure depends on the cat and on how well the diabetes responds to treatment. Even cats that stay on insulin for life can live comfortably with good control. ### How can I tell if my diabetic cat has a urinary tract infection? You cannot tell reliably at home. Straining, small frequent puddles, crying in the box, or blood in the urine point toward infection, while large urine volumes point toward poor glucose control. Your veterinarian can check a urine sample and, if needed, send a culture. ### Does drinking more water cause the accidents? No, the drinking is a response to the water loss, not the cause. High sugar in the urine pulls water out of the body, which leads to dehydration and a strong thirst drive [1]. Restricting water will not fix the problem and can harm your cat. ### Will better blood sugar control stop the peeing? In most cats, yes. Reducing high blood sugar reduces the amount of sugar and water in the urine, which lowers urine volume and accidents. If accidents continue despite good control, ask your veterinarian to check for an infection or another condition. ## Related Articles - [How to Tell If Your Cat's Increased Thirst Is a Sign of Kidney Disease or Diabetes](/knowledge/veterinary-medicine/senior-and-chronic-care/cat-increased-thirst-kidney-disease-or-diabetes) - [Why Is My Cat Losing weight rapidly? Hyperthyroidism, Diabetes & CKD](/knowledge/veterinary-medicine/symptom-guides/why-is-my-cat-losing-weight-rapidly-hyperthyroidism-diabetes-ckd) - [Cat Excessive Thirst and Urination: When to See the Vet](/knowledge/veterinary-medicine/digestive-and-urinary-care/cat-excessive-thirst-urination) - [Cat Straining To Pee](/knowledge/veterinary-medicine/behavior/cat-straining-to-pee) - [Insulin Glargine for Cats: Feline Diabetes Dose and Glucose Curve](/knowledge/veterinary-medicine/calculators-clinical-tools/insulin-glargine-for-cats-feline-diabetes-dose-and-glucose-curve) - [What Can Cause A Urinary Tract Infection In A Cat](/knowledge/veterinary-medicine/clinical-methods/what-can-cause-a-urinary-tract-infection-in-a-cat) - [Incontinence in Cats: Causes and When to See a Vet](/knowledge/veterinary-medicine/digestive-and-urinary-care/cat-incontinence-causes) - [Cat Incontinence: Causes and Treatment Options](/knowledge/veterinary-medicine/digestive-and-urinary-care/cat-incontinence-causes-treatment) - [Cat Losing Bladder or Bowel Control: Causes and Urgency](/knowledge/veterinary-medicine/digestive-and-urinary-care/cat-losing-bladder-bowel-control) ## References 1. [Feline Diabetes](https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/feline-diabetes). Cornell University College of Veterinary Medicine. 2. [Diabetes Mellitus in Dogs and Cats - Endocrine System](https://www.merckvetmanual.com/endocrine-system/the-pancreas/diabetes-mellitus-in-dogs-and-cats). Merck Veterinary Manual. 3. [Sensory profile of cats with potential pain-related diabetic neuropathy](https://pubmed.ncbi.nlm.nih.gov/41427741/). The Veterinary record, 2025. 4. [A two-center, randomized controlled trial to determine the effect of 12 weeks of caloric restriction with a novel diet in overweight cats with diabetes mellitus](https://pubmed.ncbi.nlm.nih.gov/41818731/). Journal of veterinary internal medicine, 2026. 5. [Diabetic remission in a newly diagnosed diabetic cat treated with SGLT2 inhibitor](https://pubmed.ncbi.nlm.nih.gov/41674533/). JFMS open reports, 2026. 6. [Cushing's Syndrome associated with diabetes mellitus in a Persian cat: clinical features, diagnosis, and therapeutic management](https://pubmed.ncbi.nlm.nih.gov/42592381/). Brazilian journal of veterinary medicine, 2026. 7. [2026 AAHA Diabetes Management Guidelines for Cats](https://pubmed.ncbi.nlm.nih.gov/42014100/). Journal of the American Animal Hospital Association, 2026. 8. [Reversible congestive heart failure associated with diabetes mellitus in two cats](https://pubmed.ncbi.nlm.nih.gov/42211181/). JFMS open reports, 2026. 9. [Spectrum of veterinary care in feline diabetes mellitus](https://pubmed.ncbi.nlm.nih.gov/41251300/). Journal of feline medicine and surgery, 2026. ## Further Reading - [Merck Veterinary Manual: Cat Owners](https://www.merckvetmanual.com/cat-owners) - [Cornell Feline Health Center: Health Information](https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information) - [American Veterinary Medical Association: Pet Care](https://www.avma.org/resources-tools/pet-owners/petcare)