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Insulin choices for cats: What works best (Proceedings)

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Apr 01, 2010

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