Page 209 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 209

WSVA7-0449
INTERNAL MEDICINE II
FELINE DIABETES - MAXIMIZING DIABETIC REMISSION
J. Rand1,2
1School of Veterinary Science, University of Queensland, Queensland, Australia
2Australian Pet Welfare Foundation, Brisbane, Australia
MANAGEMENT OF FELINE DIABETES MELLITUS: MAXIMIZING REMISSION
Emeritus Professor Jacquie Rand BVSc, DVSc, MACVS, Dip ACVIM;
The University of Queensland, Brisbane Australia Executive Director, Australian Pet Welfare Foundation MANAGEMENT OF FELINE DIABETES
Therapy for diabetes should be instituted as soon
as possible after diagnosis with the main goal being remission; euglycaemia without the need for insulin therapy. For cats not achieving remission the goals are resolving clinical signs and avoiding hypoglycemia. Insulin and dietary modi cation are the principal therapies used for management of diabetic cats.
Feeding
Diets low in carbohydrates and high in protein reduce post-prandial hyperglycaemia and insulin concentrations in healthy cats. Initial data in diabetic cats suggests
these diets result in better clinical control, reduced insulin requirements and increased rates of diabetic remission. Thus a commercial low carbohydrate diet should be used in diabetic cats, unless contraindicated by other disease.
Obesity in cats reduces insulin sensitivity, and hence obese cats should be fed an energy restricted diet so they lose 1-2% body weight per week.
Insulin therapy
Long-acting insulin is the preferred treatment to achieve remission. Achieving good glycaemic control with intermediate acting potent insulins such as NPH and lente is often dif cult. Long-acting insulins glargine
and detemir provide better glycaemic control, reduced risk of clinical hypoglycaemia and a signi cantly higher probability for remission when given twice daily with a low carbohydrate diet.
Cats presented with diabetic ketoacidosis can be treated with glargine intramuscularly or intravenously, as when injected this way it acts like regular insulin and can be used for initial stabilization.
Glargine
Glargine is a long-acting human synthetic insulin analogue. It should not be mixed or diluted. In cats
once daily administration produces a similar mean daily glucose concentration and area under the 24hr glucose curve as PZI, and both had signi cantly lower values than lente insulin. Glargine produced a glucose nadir later than PZI or lente, and had longer duration of action (22hrs) than lente.
However, glargine has a longer effect if administered BID compared to once daily. Once daily administration produces similar remission rates to twice daily dosing of lente insulin. Twice daily dosing is recommended as excellent glycaemic control facilitates remission, and glycaemic control is superior if glargine is injected twice daily.
Glargine can be safely instituted at 0.5U/kg bid and serial blood glucose curves should be obtained daily
for 3 days. When using glargine, it is often more useful to assess pre-insulin glucose concentration rather than the nadir glucose as it often takes 3-5 days for a good glucose-lowering effect to be seen. This may be due
to the long duration of action and carry-over effect of glargine. Almost all cats will need to have their initial dose reduced within 2 weeks and many will achieve remission within 4 weeks. Glargine can also be used intramuscularly in combination with subcutaneous insulin for treatment of ketoacidosis.
Detemir is a new long-acting synthetic insulin analogue which can be diluted with saline or water prior to injection. Detemir results in similar remission rates and time to remission as glargine, but the median maximum dose used (1.75 IU/cat BID) is less than with glargine (2.5 IU/cat BID)
Monitoring and adjusting insulin dose when using glargine or detemir should be based on pre-insulin and nadir glucose concentration, water intake, urine glucose concentration and clinical assessment (Table 1). Pre- insulin glucose concentrations measured at home are
an excellent tool for modifying daily doses of glargine
or detemir. Cats treated with glargine should have a negative, 1+ or 2+ urine glucose (scale 0-4+) and a value of 3+ or 4+ suggests a dose increase is required.
The good glycaemic control achieved when using glargine or detemir likely reverses glucose toxicity of B-cells, facilitating endogenous insulin production and a reduced requirement for exogenous administration. Insulin dose may be reduced sequentially as indicated by blood glucose concentration, urine glucose and water intake, until the dose is 1⁄2-1U/cat SID prior to Insulin may then be withdrawn, and the cat monitored
An Urban Experience
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