Page 210 - ONLINE PROCEEDING BOOK WSAVA 2017
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210
An Urban Experience
to ensure continued remission. Even if normoglycaemic, it is recommended that insulin is not withdrawn within 2 weeks of commencement of therapy. Newly diagnosed diabetic cats that have good glycaemic control within the  rst few weeks of therapy, are very likely to go
into diabetic remission. Cats that have been long- term diabetics eg >6 months are less likely to go into remission, probably because of progressive B-cell loss associated with glucose toxicity.
In conclusion, glargine and determir are safe and effective in treating feline diabetes and are the preferred insulins in newly diagnosed diabetic cats. Long-term diabetic cats should be changed to glargine or detemir if there is poor glycaemic control or owners wish to pursue once daily injections. High remission rates are expected in newly diagnosed cats when combined with a low- carbohydrate diet and twice daily injections.
Monitoring therapeutic ef cacy
Response to treatment can be evaluated using owner assessment, clinical signs, and changes in body weight and water intake. The pre-insulin glucose concentration is important when using glargine, detemir and PZI,
as there is often a persisting effect from the previous injection. Nadir (lowest) glucose concentration limits the dose increase that can be made when nadir glucose concentration is in the lower end of the normal reference range.
When using other insulins (eg lente or NPH), dosage changes are usually based on nadir blood glucose. Pre- insulin glucose, time to nadir and the time to return to baseline are also used where appropriate (table 2).
Table 1. Parameters for changing insulin dosage when using insulin glargine or detemir in diabetic cats.
Parameter used for dosage adjustment
Change in dose
Begin with 0.5 U/kg if blood glucose (>360 mg/dL (> 20 mmol/L) or 0.25/kg of ideal weight if blood glucose is lower. Do not increase in  rst week unless minimum response to insulin occurs or are using home blood glucose montoring, but decrease if necessary. Monitor response to therapy for  rst 3 days If no monitoring is occurring in  rst week, begin with 1 U/cat BID
If pre-insulin blood glucose concentration >216mg/dL (>12mmol/L) provided nadir is not in hypoglycaemic range or If nadir blood glucose concentration >180mg/dL (>10mmol/L)
Increase by 0.25-1U
If pre-insulin blood glucose concentration 180<216mg/dL (> 10 - <12mmol/L) or Nadir blood glucose concentration is 90-160mg/dL (5-9mmol/L)
Same dose
If nadir glucose concentration is 54-72 mg/dL (3-4 mmol/L)
Use clinical signs, water drunk, urine glucose and next pre-insulin glucose concentration to determine if insulin dose is decreased or maintained.
If pre-insulin blood glucose concentration <180mg/dL (10 mmol/l) or If nadir blood glucose concentration < 54mg/dL (<3 mmol/l)
Reduce by 0.5- 1UU or if total dose is 0.5-1U SID, stop insulin and check for diabetic remission
If clinical signs of hypoglycemia are observed
Reduce by 30-50%
If blood glucose measurements are not available:
If water intake is <20mls/kg on wet food or <60mls/kg on dry food
Same dose
If water intake is >20mls/kg on wet food or >60mls/kg on dry food
Increase dose by 0.5-1U
If urine glucose is > 3+ (scale 0 - 4+)
Increase dose by 0.5-1U
If urine glucose is negative
Decrease dose until 0.5-1 U SID and then check for diabetic remission
42ND WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND FECAVA 23RD EUROCONGRESS


































































































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