Insulin choices for cats: What works best (Proceedings)

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Insulin choices for cats: What works best (Proceedings)

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Apr 01, 2010
12Next 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 12Next