Bexacat: Oral Treatment for Cats with Diabetes

Most pet parents will never have to experience what it is like to treat diabetes in cats, as it is diagnosed in approximately 1 percent of cats. Diabetes mellitus results in frequent trips to the veterinary office, testing, blood draws, and twice daily injections of insulin with strict rules on timing and accompanying diet.

For many pet parents, the management of their cat’s diabetes with insulin is too much to handle and they seek other treatment options. Fortunately, there is a new option on the market—a tablet that is given once per day. Unfortunately, not every cat with diabetes is able to take this medication. Read more to better understand if Bexacat (bexagliflozin tablets) is right for your cat.

What Is Bexacat?

Bexacat is an alternative to providing injections of insulin, a hormone. It is indicated to improve glycemic control in otherwise healthy cats with diabetes mellitus not previously treated with insulin.

The active ingredient is bexagliflozin, a medication that stops a protein in the body from holding onto a lot of blood glucose (i.e. blood sugar) in the urine. Bexagliflozin belongs to a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Bexacat was approved by the U.S. FDA in December 2022 and is manufactured by Elanco. Because it is relatively new, not all veterinarians keep this in stock or regularly recommend it. However, veterinarians can order it. The product is not widely available online yet. There are no generics available at this time.

What Does Bexacat Look Like?

Bexacat tablets are in the shape of a pentagon (five-sided), 1 cm (~2/5 inch) wide, and tan to brown in color. It is chewable and flavored.

What Is Bexacat Used for in Cats?

Bexacat is used in cats diagnosed with diabetes mellitus. Diabetes mellitus is the condition of having too high of blood glucose (i.e. blood sugar) due to either not enough insulin in the body or the body not using insulin that is there. Insulin allows cells to take in glucose from the bloodstream and convert glucose into energy. Glucose is a very important form of energy for all of the body’s cells. If glucose is not available, cells cannot function properly. Cats with diabetes mellitus require treatment in the way of medications as well as diet and exercise changes.

Diabetes mellitus has two types in people that are similar to cats. Type I diabetes means the body is not producing enough insulin. This is very rare in cats (approximately 5 percent of cases), and most often occurs due to pancreatitis that occurred for a long time or many different times. Type II diabetes means the body has plenty of insulin, but either the cells in the pancreas cannot properly release it or insulin was released but does not properly interact with cells, called insulin resistance.

Bexacat ideally would not be used in cats with Type I diabetes. Cats with Type I diabetes should receive insulin since their bodies cannot produce it. However, there is no accurate way of confirming whether a cat has Type I or Type II diabetes.

Bexacat decreases the levels of blood glucose, improving the health of your cat. Cats who can take Bexacat:

• Have not been previously treated with insulin
• Do not have any health complications from diabetes
• Do not currently have or have a history of pancreatitis (inflammation of the pancreas)
• Have no evidence of kidney or liver disease
• Do not have diabetic ketoacidosis, a life-threatening metabolic state when cats have not had enough insulin for a long time, and the body starts breaking down fat into ketones. Ketones build in the bloodstream and poison your cat

Many times, pet parents realize something is truly wrong with their cat when they become lethargic or aren’t eating well. In these cases, if the cats are diabetic, Bexacat could not be used, since the medication is for otherwise healthy cats.

How Does Bexacat Work?

Bexacat stops sodium-glucose linked transporter 2 (SGLT2), which is a protein that takes glucose from the tubules in the kidneys (i.e. from the urine) and puts it back into the bloodstream. SGLT2 is responsible for resorbing approximately 90 percent of the glucose in the urine. Because Bexacat stops this process from happening, the glucose passing through the kidneys goes out into the urine instead of staying in the body.

Bexacat does not work the same as insulin. Insulin comes from the pancreas and allows glucose to enter individual cells from the bloodstream, decreasing blood glucose. Bexacat decreases blood glucose by increasing the amount of glucose exiting the body in the urine.

How to Give Bexacat to Cats

Bexacat should be given once every 24 hours and can be given with or without food. Bexacat tablets are chewable, flavored tablets. Cats can eat it out of your hand like a treat, or it can be put into food. These tablets can be crushed and should taste good enough for most cats to eat. If the medication is crushed into food, feed your cat a small amount of food with the medication first to ensure they eat all of the medication in one sitting. 

Bexacat Reviews and Comparison

Avoiding insulin and injections twice daily is very appealing when managing cats with diabetes mellitus. Insulin must be given after your cat has eaten a meal, and thus cats must be fed two distinct meal times every day as opposed to free-feeding. If your cat doesn’t eat at mealtime, treatment gets really complicated. The fact that Bexacat is crushable and flavored will likely make the tablet easy to administer.

Bexacat is still a fairly new medication, so many veterinarians are not accustomed to recommending this product or the specific type of monitoring that should be done after starting the product. Cats who are prescribed this medication should be newly diagnosed diabetics without systemic symptoms like decreased activity or appetite. For this reason, many veterinary patients are not eligible to use the product.

Cats treated with Bexacat may be at an increased risk of a life-threatening disease known as diabetic ketoacidosis or a new clinical syndrome called euglycemic diabetic ketoacidosis. Cats with euglycemic diabetic ketoacidosis can be in the dangerous health state of diabetic ketoacidosis, but instead of having very high blood glucose, glucose readings are in the normal range. Possible side effects like this make some veterinarians concerned about which patients they should offer the medication to.

There are studies looking at Bexacat and similar medications in cats that support the use of these medications. There is still much to be learned about how this medication can support feline patients.

Bexacat vs Insulin Comparison Chart

	Bexacat	Insulin
Form	Tablet	Injection
How to Give	By mouth	By needle, under the skin
Dosage	1 tablet (15mg)	Will vary depending on insulin type and blood sugar levels
Frequency	Once daily, with or without food	Typically twice a day, after meals (ask your vet)
How it works	Eliminates excess sugar through urine	Stimulates sugar intake into cells
Storage	Room temperature	Requires refrigeration

Bexacat Side Effects

There are side effects reported for Bexacat during clinical trials, but keep in mind that cats with diabetes mellitus are at risk for the same side effects. Side effects may include:

• Vomiting
• Diarrhea
• Decreased appetite
• Decreased activity
• Severe versions of the above symptoms caused by diabetic ketoacidosis
• Weight loss
• Blood in the urine or changes in litter box habits due to urinary tract infections
• Ongoing increased urine and drinking (approximately 1/3 cats), which would normally stop or largely decrease once blood sugar was normalized

Monitoring your cat for the first two weeks of therapy with Bexacat is crucial to detecting diabetic ketoacidosis quickly, as the first two weeks are when your cat is most at-risk. Bexacat should be stopped immediately if while on medication your cat suddenly stops eating, is much less active, or has lost weight. Bloodwork and an examination is recommended at two weeks (or sooner if concerns), as well as four weeks and eight weeks after starting therapy. Blood glucose curves involving all-day hospital stays are necessary as well as other forms of bloodwork and urine testing at each visit. It is similar to the monitoring of cats receiving insulin, but additional blood work is recommended.

Reactions with Other Drugs and Medications

No currently known food or drug reactions exist. However, since Bexacat is fairly new on the market, adverse reactions may be discovered later. As with all diabetic cats, veterinarians will avoid providing other prescriptions that may further dehydrate your cat, such as diuretics.

Bexacat Dosing

All cats who weigh at least 6.6 pounds will be given one tablet of 15 milligrams every 24 hours. Kittens can use the medication, but diabetes mellitus is rarely diagnosed in such young cats.

Bexacat Cost

Bexacat costs approximately $90 per 30-day supply. This cost is comparable, if not less, than traditional insulin treatment.

Bexacat Storage Instructions

Keep all tablets at room temperature (68-77 degrees Fahrenheit), stored in the original container as much as possible.