Insulin treatment options for Diabetic Cats
A. Stable versus unstable
1. ketotic versus nonketotic
2. attitude
3. appetitie
4. activity level
B. Unstable patient – ketotic/ketoacidotic/hyperosmolar diabetic
1. Goals of therapy
a. correct dehydration/restore normal fluid balance
b. provide insulin
c. correct electrolyte imbalances
d. correct acidosis
e. identify precipitating cause
2. Fluid therapy
a. total body sodium loss
b. 0.9% NaCl w/ K+ (as needed)
c. usually fine even if hyperosmolar
d. correct dehydration and account for ongoing losses
3. Insulin therapy – use Regular crystalling insulin
a. Insulin CRI
(1) blood glucose q 2hr
(2) continuous blood glucose monitoring
b. Intermittent IM/SQ technique
(1) 0.2 U/Kg IM
(2) 0.1U/kg IM q 1 hr until blood glucose <250 mg/dl
(3) regular insulin SQ 0.5-1 U/kg q 6-8 hr once patient is hydrated
4. Correction of electrolyte balances
a. Potassium supplementation
(1) initial
(2) once insulin starts
(3) can add to fluids
b. Phosphorous supplementation
(1) once level gets < 1.5 (dog), <2.5 (cat)
(2) 0.01-0.03 mmol/kg/hr for 6 hours and recheck
c. Magnesium supplementation will help get other electrolyte levels up important in parathyroid hormone synthesis
and in correcting hypocalcemia (3) 0.75 – 1.0 mEq/kd/day IV in 5% dextrose over 24-48 hrs
5. Correction of acidosis
a. IV fluids
b. bicarbonate if acidosis severe (<7.0) or doesn't correct with rehydration
c. 0.1 x base deficit x BW (kg) – give 1/3 and recheck
6. Wean to long acting insulin when animal is hydrated and eating. Still may have small amounts of ketones in
urine.
C. Stable diabetic, eating/drinking/good attitude
1. Goals of therapy
a. control clinical signs of pet
b. prevent hypoglycemia
c. keep blood glucose between 100-300 mg/dl for most of the animal's day; ideally want blood glucose between
100-200 mg/dl
d. animal to regain normal muscle mass and body weight
