Feline Diabetes Mellitus Flashcards
What sex, breed and age of cats are more at risk for developing diabetes mellitus?
- Males > females
- Burmese cats
- Biphasic age peaks: 5-7 yrs old, or 12-14 yrs old
What concurrent medications are a risk factor for causing diabetes mellitus in dogs and cats?
Corticosteroids!!!
- cortisol competes w insulin, worsening hyperglycemia
- Also megestrol aceteate
How does Type II DM lead to peripheral insulin resistance?
- Amyloid is secreted when insulin is secreted
- Constant insulin release leads to accumulation of amyloid in beta cells of the endocrine pancreas
- Leads to ↓ blood supply, ↓ insulin response to ↑ glucose, and ↓ insulin secretion
How is obesity a risk factor for developing Type II DM in cats?
50% ↑ wt = 50% ↓ in insulin sensitivity
- Fat cat has to produce 2x as much insulin → more prone to insulin resistance and amyloid deposition
85-95% of cats get Type _____ diabetes mellitus
2
(Beta cell failure → insufficient insulin secretion, reduced insulin sensitivity)
50% of cats with diabetes mellitus have concurrent _________ disease
Pancreatitis
(pancreatitis can cause DM, but DM can also cause pancreatitis… hard to tell what came first)
True or False: Cats with Type II DM are insulin dependent and do not go into remission
False - Type II DM can go into remission!! Type I is insulin dependent
What drug should be avoided in a cat in remission from Type II DM?
don’t give steroids !!! cortisol competes w insulin
A cat presents for polydipsia and urinating outside of the litter box. What are the top 5 Ddx for PU/PD in cats?
- Kidney dz
- Diabetes mellitus
- Hyperthyroidism
- Hypercalcemia
- Liver failure
A cat presents for polydipsia and urinating outside of the litter box. What are the top 5 Ddx for pollakiuria in cats?
Pollakiuria = increased frequency of urination
- iFLUTD
- UTI
- Cystolith
- Behavioral
- OA
- PU/PD
What are the clinical signs seen in cats with DM?
- PU/PD
- Weight loss
- ↑ weight loss
- Poor hair coat (dull, sticky)
- 10% of cats with DM have neuropathic DM → plantigrade stance
True or False: Neuropathic DM causing plantigrade stance is usually irreversible
False - reversible after stablizing DM
A 13yr old cat presents for polydipsia and urinating outside of the litter box. A urinalysis is ran.
Glucose: +++
USG: 1.035
What can you say from these results?
- USG is useless and unreliable, glucosuria causes false ↑ in USG
A 13 yr old cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and the blood glucose is 425. How can you tell if the hyperglycemia is due to diabetes mellitus or stress associated with the vet visit?
- Run a Fructosamine
- If fructosamine is HIGH, you know the cat has been hyperglycemic for atleast 2 weeks
What are the Ddx for plantigrade stance in cats?
- Hypokalemia
- Diabetic neuropathy/DM
True or False: Auto-antibodies to Lente insulin must be considered in an unstable diabetic, especially in cats > dogs
False!
Antibodies against insulin have not been reported in cats, but definitely has been reported in dogs
How is blood pressure affected by diabetes mellitus in cats?
DM does not necessarily cause hypertension in cats (it does in dogs), but secondary causes of DM (Ex: HyperAdrenocortisism, Acromegaly) do predispose an animal to hypertension…. so hypertension is somewhat common finding in DM patients
A 13 yr old cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and find a glucose level of 425, elevated ALT and ALKP, and a low T4. How can you interpret the low T4?
Diabetes causing euthyroid sick syndrome…. can’t say anything about it. Must clear underlying issue and reassess!
A cat presents for polydipsia and urinating outside of the litter box. You run a minimum database and find a glucose level of 425, elevated ALT and ALKP, and a low T4. What could be the cause of the elevated ALT and ALKP?
Hepatic lipidosis common in DM cats
What is the diet of choice for a diabetic cat?
High protein low carb diet, ad lib feeding
(Dogs: high fiber low carb diet)
Which of the following insulin has the highest rate of remission in cats with DM?
A. U-40 pork lente
B. Glargine
C. Detemir
D. PZI
E. NPH
B. Glargine
(works for 24 hrs and is cumulative)
______% of cats with DM can go into remission
50-90%
What is typically the first clinical sign of hypokalemia seen in cats?
Inappetance
Why is a blood pressure measurement included in the workup of a diabetic patient?
- Dogs w DM predisposed to hypertension
- Secondary causes of DM like HyperAdrenocorticism and Acromegaly predispose cats to hypertension
How is a high protein diet beneficial for management of diabetic cats?
↑ protein → ↑ effectiveness of hexokinase → less glucose in blood → ↓ CS of DM
↑ protein → decreases postprandial glucose surge
List the SGLT2 inhibitors used to manage newly diabetic cats
- Velagliflozin
- Benagliflozin
What considerations must be made when deciding whether to start a SGLT2 inhibitor?
- Must be used without insulin
- Must not have recently received insulin
- Not for DKA patients
- Only used in cats with DM
Which of the following insulin types can cause a variation in BG levels, intermittent glucosuria, and peaks and troughs on a BG curve?
Lente insulin (harder to enter remission)
How can you interpret a BG curve showing a high flatline at 450.
- Either insulin resistance or giving too little insulin
How would you interpret a BG curve showing evidence of Somogyi?
A. The patient needs more insulin
B. The patient needs less insulin
C. The patient needs a longer acting insulin
D. The patient is demonstrating insulin resistance
B. The patient needs less insulin
List all treatment options for managing DM in cats
- Insulin
- Glipizide PO
- a-glucosidase inhibitors
- Incretins
- SGLT2 inhibitors (Velagliflozin, Benagliflozin)
- High protein low carb diet
(Different from dogs: Only insulin and high fiber low carb diet used for tx of DM in dogs)
