The new treatments — diabetic cats in the biggest shift in a century

For a hundred years after insulin's discovery in 1921, diabetes treatment had a single grammar — "give the injection." That grammar is now shifting, and feline medicine is where it shows: two oral drugs approved back to back in 2022 and 2023, a flatter and longer new insulin, cousins of human Ozempic, and research reaching toward once-monthly dosing. This disease is improving faster than any other in this series.

The final chapter is a map of that horizon, on the same principle as the rapamycin chapter: news sells excitement; a map tells you where things stand. Drawing the line between treatments that have arrived and treatments still in research is this chapter's job.

1. The revolution that has arrived — the oral drug (SGLT2)

• What happened — in December 2022, Bexacat (bexagliflozin tablets) became the first SGLT2 inhibitor approved in any animal species; Senvelgo (velagliflozin oral solution) followed in 2023. For the first time in a century, injection-free diabetes treatment is an official option
• What it changes — a once-daily oral dose restructures chapter 10's sustainability problems wholesale (the 12-hour clock, backup caregivers, needle fear), with essentially no hypoglycemia risk by mechanism
• Where the line is — the eligibility conditions (newly diagnosed, otherwise healthy) and chapter 08's price (normal-glucose ketoacidosis, the first-two-weeks watch) stand unchanged. An arrived revolution — not a universal one

2. Crossing the bridge — the new insulins

• Glargine U300 (Toujeo) — a triple-concentrated version of the glargine we use, producing a flatter, longer curve. A small feline study found it effective and safe, with 44% of newly diagnosed cats reaching remission — promising, but small; large comparative trials are the unfinished half of the bridge. Some clinics already use it, so it is a discussable topic
• Once-weekly insulin — in human medicine, once-weekly basal insulin (icodec) is already reality. Nothing feline yet, but the direction is plain: someday the twice-daily clock becomes a weekly calendar. The reason chapter 10 of this book may one day grow shorter

3. The horizon's lead — GLP-1 (Ozempic's cousins)

• The evidence so far — feline studies adding exenatide to insulin report better glycemic control, lower insulin requirements, less glucose variability and less weight gain. The 2025 international feline consensus guidelines placed it as "not routine, but worth individual consideration in cats with remission potential and cats needing weight loss"
• The technology's direction — a sustained-release formulation lasting a month per injection is being studied in cats. If it lands, it stops being an adjunct and becomes a card that restructures care itself
• Where the line is — no feline-approved product yet; use remains research and specialist territory. "Ozempic for cats" is still horizon, not news

4. The ultimate goal — medicine that saves the beta cell

• This disease's true finish line is not glucose control but recovery of the insulin-producing cells. Stem-cell and regenerative research runs in both human and veterinary medicine, but feline clinical work is at the earliest of stages
• And the twist — a beta-cell-saving treatment already lives inside this book. Chapter 04's early tight control is exactly that: rescuing beta cells from glucose toxicity fast enough to buy them time to recover — the only validated "beta-cell regeneration" medicine currently owns. While waiting for the new treatments, the task is not waiting; it is using the golden window

5. The companion front — evolving acromegaly treatment

The one-in-four disease (chapter 09) has a moving front line too: pituitary surgery centres are multiplying, reports on the oral option (cabergoline) accumulate, and SGLT2 drugs widen their role in managing inoperable cases. This book's sentence — "uncontrolled means IGF-1" — grows more valuable as the options grow: there is more and more to offer the culprit once found.

6. Standing before new treatments — three principles

• ① Your vet before the news — save the article, bring it to the consult. One question — "does this mean anything for this cat, now?" — turns news into a point on the map
• ② Use everything that has already arrived — low-carb wet food, home monitoring, early tight control, SGLT2 where eligible. The household using all the arrived medicine is also the one best positioned to greet the horizon's
• ③ The clinical-trial door — university hospitals and specialty centres are the legitimate front row for new treatments. If the conditions fit, asking your vet about ongoing studies is worth the sentence

7. What to ask your vet

• "Is this cat eligible for the SGLT2 drug? If not, on which condition does it fail?"
• "Have you used the newer insulins like glargine U300? Is there a reason for this cat to switch?"
• "(Poor control / weight loss needed) would the GLP-1 class be worth discussing in this case?"
• "Are any feline diabetes studies running at nearby university hospitals or centres?"
• "When I see news of a new treatment, which channel should I bring it through?"

8. Related — and a word at the finish

• The big picture of treatment — the two arrived roads, in full
• Remission — the best "new treatment" in existence: the golden window
• The HCM Bible: rapamycin — how to read another disease's horizon
• The Diabetes Bible — contents — from the top, or just the chapter tonight needs

With this chapter, all twelve chapters of the Diabetes Bible are filled. From the kitchen floor on diagnosis day, past the syringe and the glucometer, through the possibility of remission and a sustainable ordinary life, to this horizon — this book's goal is the day it is no longer needed. Until then, take out the chapter you need on the night you need it.