Feline Diabetes Mellitus Flashcards
What type of cats are at increased risk?
Older, indoor, male cats
What are the causes of DM in cats?
Sustained insulin resistance
Secondary to chronic pancreatic disease
Dietary influences
What cat breeds are predisposed to DM?
European and Australian Burmese cats
What causes insulin resistance in cats?
Obesity
Lack of exercise and poor muscle mass
Endocrinopathies
Drugs
Inflammatory conditions
How does obesity cause DM in cats?
4x increased risk
Number 1 cause of insulin resistance
Related to adipokines produced by fat cells
Inflammatory condition
What endocrinopathies contribute to DM in cats?
Hypercortisolism
Hyperthyroidism
Acromegaly
How does acromegaly cause DM in cats?
Growth hormone secreting pituitary tumor
GH is a very powerful antagonist to insulin
What drugs can cause DM in cats?
Glucocorticoids (prednisolone, DepoMedrol) and progestagens (Megestrol acetate)
How do inflammatory conditions cause DM in cats?
Cytokines antagonize the effect of insulin
How do inflammatory conditions cause DM in cats?
Cytokines antagonize the effect of insulin
Chronic inflammation
How does a poor diet cause DM in cats?
Incretins - specifically GLP1 have powerful trophic effects on beta cells
The best stimuli for the incretins in cats are fats and proteins
High carb diets are BAD
Diets with <14% of ME from carbs are recommended
How does insulin resistance occur?
More insulin is needed to get the job done
Amylin is co-secreted with insulin
Amylin is poorly soluble and gets stuck in the pancreas
Results in pancreatic amyloidosis
Causes progressive compromise to beta cell function
What BG causes glucose toxicity?
> 200 mg/dl
What happens when BG goes >200 mg/dl?
Diabetic neuropathy
Apoptosis of beta cells
What happens when BG goes >250 mg/dl?
Pu/pd
What is the renal glucose threshold in cats?
250 mg/dl
What are the clinical signs of DM in cats?
Polyuria
Polydipsia
Polyphagia
Weight loss
Diabetic neuropathy
Causes of insulin resistance
Does hyperglycemia in a cat = diabetes mellitus?
No, need to prove a persistent hyperglycemia
What would you see in a urinalysis of a DM cat?
Glucosuria
Can have ketonuria
Often concentrated urine despite sever pu/pd
Could have UTI
What would you expect to see on a chemistry of a DM cat?
Hyperglycemia
Hypercholesterolemia
Hypertriglyceridemia
Hyponatremia
What is a serum fructosamine measurement for?
Amount of fructosamines is proportional to BG levels
Allows us a look back over the previous 1-2 weeks
Amounts are lowered by diseases that impact albumin turnover
Be careful for Somogyi overswing
What is the #1 goal of treatment?
A satisfied owner
What are suitable first choice insulins for cats?
Insulin glargine and PZI
What is the starting dose of insulin for cats?
1 unit/cat BID or 0.25 U/kg
What is the best option for monitoring?
BG measurements at home
What is the Somogyi overswing?
Super low glucose, body causes glucose to skyrocket for about a day
Will miss a super low if using fructosamine - will show a high average
Why is measurement of water intake unreliable?
BG generally >250 mg/dl before polydipsia occurs
How should you go about adjusting the insulin dose?
Nadir <80 mg/dl = decrease the dose by 25-50%
BG 80-250 mg/dl all day = keep dose
Nadir >150 mg/dl = increase dose by 1/2 unit
Cat should be showing signs indicating hyperglycemia
Allow several days to see effect before increasing again
What option might be effective when used once daily in cats and why?
Insulin glargine U-300
Strong concentration slows release from the SQ space
What does SGLT-2 inhibitor do?
Prevent glucose uptake by the renal tubules
Lowers BG via urine loss
When does remission most often occur?
Within the first 90 days
What cats are unlikely cats for remission?
Steroid dependent
Chronic disease
Dietary issues
Peripheral neuropathy
