Should cats on an SGLT-2 inhibitor go on a special diet?

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, answers a common question from caregivers of cats with diabetes: should a cat receiving a sodium-glucose cotransporter 2 (SGLT2) inhibitor be placed on a specific diet? As Behrend explains, she recommends still following the traditional diet for a cat with diabetes, which consists of a high-fat, high-protein, low-carbohydrate nutrition. In the video, she delves into the reason behind this.

Below is the interview transcript, which has been lightly edited for improved clarity:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): So a really common question is about diet in combination with an SGLT-2 inhibitor: Do you put a cat on a specific diet? And when?

So, I still recommend the typical diabetic cat diet: high fat, high protein, low carbohydrate in combination with an SGLT-2 inhibitor, there's some evidence in people that such a diet could increase the risk of [diabetic ketoacidosis] (DKA). We don't know in cats—cats handle carbohydrates hugely different than people do, so until we know better or differently, I'm going to use a high fat, high protein, low carbohydrate diabetic diet because it can really help with putting a cat into remission, at least when the cat is on insulin.

I typically don't change the diet for 2 weeks after starting the SGLT-2 inhibitor or until I think the cat is settled and doing well. I don't want to do 2 things that can cause vomiting and softening of the stool at the same time: change the diet and start the drug, because then you're not going to know what the problem is. So, I start the SGLT-2 inhibitor first and then after 2 weeks, when the cat's doing fine, or whenever that is—typically around 2 weeks—then I'm going to start the diabetic diet.