The diabetic cat (Proceedings)
Is the feline diabetic patient every veterinarian's nightmare? Since diabetes mellitus is one of the most common endocrinopathies in cats, it is likely you will face this disease many times in your veterinary career. The focus of this presentation will be to discuss the problems you may encounter with your feline diabetic foes using case studies to illustrate how these feline diabetics can be your friends.
What is good control?
Resolution of clinical signs
Water consumption, urination habits, appetite, activity, weight gain/loss, grooming behavior
Weight loss/gain, blood glucose spot checks, curves, fructosamine levels
Suspect insulin resistance when
• Dose of insulin is 6-8U (cat) q.12h and all BG levels >300 mg/dl
Insulin resistance problems: The hunt for the problem(s) begins...
• Consider: client related, insulin related and/or patient related issues.
• Vary location of injection sites.
Every diabetic cat, especially those that are difficult to regulate, should have a full physical examination, complete diagnostic evaluation (CBC, biochemistry profile, serum T4, urinalysis), blood pressure measurement, and fructosamine level.
Imaging studies (radiographs, ultrasound) and more extensive testing may be needed to rule out concurrent diseases.
Don't forget to check for urine ketones.
• Ketones are the end-product of rapid or excessive fatty-acid breakdown.
Treatment of choice
Varies based on doctor's experience and individual patient response
Insulin therapy (insulin insanity)
**The ideal insulin preparation has not been identified for diabetic cats.**
Lantus - insulin glargine
• This is the "insulin du Jour", but it is very effective at controlling diabetes mellitus in cats. Insulin Glargine is a long-lasting human insulin analog produced by recombinant DNA technology using a non-pathogenic strain of E coli. This insulin requires U-100 syringes. The bottle of insulin may remain potent for 2-6 months once opened.
Oral hypoglycemic drugs (cats):
• Limited use as single therapy; can be used in conjunction with insulin or other oral drugs to obtain better glycemic control.
Diet: Cats are carnivores.
Feed diet high in protein, low in carbohydrates (canned food preferred)
Manage obesity! Encourage hunting activity. Take out portion of kibble from daily measured amount. Place kibble in favorite places initially and then place kibble in less frequented areas.
Hunting = activity = calories burned.
Follow-up plan for diabetic patients
• Recheck the patient one week after starting insulin therapy. Perform blood glucose curve to determine nadir if using insulin other than Lantus. Adjust insulin based on these readings.
But what about the "difficult" diabetic?
Don't forget to consider: client related, insulin related and/or patient related issues.
Prednisolone instead of prednisone
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