Diabetes in the cat Flashcards
Non-insulin dependent DM
Cat mostly (30-40%)
Obesity-induced carb intolerance (impaired receptor binding for insulin)
Transient DM
20% of cats
Fluctuates between non-diabetic and NIDDM
Intermittent insulin resistance (obesity, steroids and acute pancreatitis)
Signalment for cats with DM
Older than 6y
Male neutered
CS of DM
PU/PP/PD
WL, leth
Dry, unkempt hair coat
Rear limb weakness
Plantigrade posture
Goals of DM therapy in cats
Don’t make patient hypoglycemic
Remission and elimination of CS
Insulin therapy for cats
PZI
NPH
Insluin Detemir
Vetsulin
Glargine
PZI
Intermediate to long acting
More acceptable duration of effect than NPH
Remission >50%
Glargine **
Slow acting insulin analog
Slow release of insulin from injection site
High remission rates
Dietary therapy for DM
High protein, low CHO
Canned preferred
High protein for WL- 15% body wt (NIDDM)
Oral hypoglycemic drugs
For non-insulin dependent DM
Stimulates pancreatic insulin secretion
Enhances tissue sensitivity to insulin
Slows postprandial intestinal glucose absorption
Sulfonylureas- Glipizide (oral hypoglycemic drugs)
Direct stimulation of insulin secretion by beta cells
Extrapancreatic effects
Candidates for Glipizide
Owners won’t give injections
Cats in and out of an insulin-requiring diabetic state
Cats that require insulin but with recurrent hypoglycemia and require low doses of insulin
Adverse effects of Glipizide
Vomiting, hypoglycemia, ↑ liver ezymes, icterus
Incidence <15%
MOA of oral hypoglycemic drugs
SGLT-2 inhibitors (oral tx)
Stopping the kidney from absorbing too much glucose
Requirements for patients on hypoglycemic drugs
Healthy newly diabetic cats never been on insulin
Not ketotic or DKA
3 kg, normal and no CS
Concurrent disorders causing insulin resistance
Obesity
Chr. pancreatitis
Renal insufficiency
Bacterial infections (UTI and periodontal dz)
Hyperthyroidism
Hyperadrenocorticism
Acromegaly
Diabetic Ketoacidosis (DKA)
Hyperglycemia + ketogenesis with deficiency of insulin and excess of glucagon
Ketosis
Insulin: transporter protein for glucose, K and P
Inadvertent atkins diet
Lack of glucose transport into cells → cell starvation and altered metabolism → PP and WL
↑ endogenous glucose act as osmotic agents → PU then PD
CS of DKA
Hx of anorexia, depression, weakness, V, D and PU (+not eating)
DKA dx
Abdominal U/S
Met. acid (ketosis and lactic acidosis), stress leuko
↓ total body K
↑ P urinary excretion
↑ ALT and ALP
Glycosuria and ketonuri
Ketones
By products of FFA oxidation by the liver (alternate energy source)
↑ ketone → electrolyte imbalance → DKA
DKA tx
Fluid and electrolytes (life theratening)
Regular insulin (CRI or injection) → when rehydrated and eating witch to SQ
Nonketotic hyperosmolar diabetes
Extreme hyperglycemia (>600 mg/dl)
Hyperosmolality (>350 )
Severe dehydration, CNS depression
No ketones
Monitoring Diabetic control
Hx and PE
Serial blood glucose curves (Alphatrak III- at home, freestyle libre)
Serum fructosamine concentration
Urine glucose and ketone monitoring
