Diabetes in the cat

Question 1

Non-insulin dependent DM

Answer 1

Cat mostly (30-40%)
Obesity-induced carb intolerance (impaired receptor binding for insulin)

Question 2

Transient DM

Answer 2

20% of cats
Fluctuates between non-diabetic and NIDDM
Intermittent insulin resistance (obesity, steroids and acute pancreatitis)

Question 3

Signalment for cats with DM

Answer 3

Older than 6y
Male neutered

Question 4

CS of DM

Answer 4

PU/PP/PD
WL, leth
Dry, unkempt hair coat
Rear limb weakness
Plantigrade posture

Question 5

Goals of DM therapy in cats

Answer 5

Don’t make patient hypoglycemic
Remission and elimination of CS

Question 6

Insulin therapy for cats

Answer 6

PZI
NPH
Insluin Detemir
Vetsulin
Glargine

Question 7

PZI

Answer 7

Intermediate to long acting
More acceptable duration of effect than NPH
Remission >50%

Question 8

Glargine **

Answer 8

Slow acting insulin analog
Slow release of insulin from injection site
High remission rates

Question 9

Dietary therapy for DM

Answer 9

High protein, low CHO
Canned preferred
High protein for WL- 15% body wt (NIDDM)

Question 10

Oral hypoglycemic drugs

Answer 10

For non-insulin dependent DM
Stimulates pancreatic insulin secretion
Enhances tissue sensitivity to insulin
Slows postprandial intestinal glucose absorption

Question 11

Sulfonylureas- Glipizide (oral hypoglycemic drugs)

Answer 11

Direct stimulation of insulin secretion by beta cells
Extrapancreatic effects

Question 12

Candidates for Glipizide

Answer 12

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

Question 13

Adverse effects of Glipizide

Answer 13

Vomiting, hypoglycemia, ↑ liver ezymes, icterus
Incidence <15%

Question 14

MOA of oral hypoglycemic drugs

Answer 14

SGLT-2 inhibitors (oral tx)
Stopping the kidney from absorbing too much glucose

Question 15

Requirements for patients on hypoglycemic drugs

Answer 15

Healthy newly diabetic cats never been on insulin
Not ketotic or DKA
3 kg, normal and no CS

Question 16

Concurrent disorders causing insulin resistance

Answer 16

Obesity
Chr. pancreatitis
Renal insufficiency
Bacterial infections (UTI and periodontal dz)
Hyperthyroidism
Hyperadrenocorticism
Acromegaly

Question 17

Diabetic Ketoacidosis (DKA)

Answer 17

Hyperglycemia + ketogenesis with deficiency of insulin and excess of glucagon

Question 18

Ketosis

Answer 18

Insulin: transporter protein for glucose, K and P

Question 19

Inadvertent atkins diet

Answer 19

Lack of glucose transport into cells → cell starvation and altered metabolism → PP and WL
↑ endogenous glucose act as osmotic agents → PU then PD

Question 20

CS of DKA

Answer 20

Hx of anorexia, depression, weakness, V, D and PU (+not eating)

Question 21

DKA dx

Answer 21

Abdominal U/S
Met. acid (ketosis and lactic acidosis), stress leuko
↓ total body K
↑ P urinary excretion
↑ ALT and ALP
Glycosuria and ketonuri

Question 22

Ketones

Answer 22

By products of FFA oxidation by the liver (alternate energy source)
↑ ketone → electrolyte imbalance → DKA

Question 23

DKA tx

Answer 23

Fluid and electrolytes (life theratening)
Regular insulin (CRI or injection) → when rehydrated and eating witch to SQ

Question 24

Nonketotic hyperosmolar diabetes

Answer 24

Extreme hyperglycemia (>600 mg/dl)
Hyperosmolality (>350 )
Severe dehydration, CNS depression
No ketones

Question 25

Monitoring Diabetic control

Answer 25

Hx and PE
Serial blood glucose curves (Alphatrak III- at home, freestyle libre)
Serum fructosamine concentration
Urine glucose and ketone monitoring