Page 210 - WSAVA2017
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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 Even if normoglycaemic, it is recommended that insulin is not withdrawn within 2 weeks of commencement of therapy.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 first 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 efficacy
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 first week unless minimum response to insulin occurs or are using home blood glucose montoring, but decrease if necessary. Monitor response to therapy for first 3 days If no monitoring is occurring in first 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

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