VETgirl Q4 2020 Beat e-Newsletter

WHAT’S NEW IN DIABETIC MONITORING IN DOGS AND CATS? CONTINUOUS GLUCOSE

MONITORING AND MORE J. CATHARINE SCOTT-MONCRIEFF, MA, MS, VET MB, DACVIM, DECVIM (continued)

which cats will do better with which insulin formulation. Cats should be carefully monitored for occurrence of hypoglycemia, because of the possibility of remission of diabetes mellitus. A blood glucose curve should be performed 7-14 days after making any change in insulin formulation. Whichever formulation is chosen, twice a day insulin therapy is more likely to result in good glycemic control than once a day therapy. If twice a day treatment is not possible, once a day therapy with PZI or Glargine can result in effective control of clinical signs in some cats. Goals of insulin treatment The primary goal of insulin therapy in diabetic patients is to control clinical signs of DM while avoiding hypoglycemia. Severe hypoglycemia can be life-threatening and even mild insulin-induced hypoglycemia can result in clinical signs of poor glycemic control due to the insulin resistance that results from secretion of anti-insulin hormones such as glucagon, growth hormone, cortisol, and epinephrine. Persistent severe hypoglycemia can lead to permanent neurologic damage. The long-term benefits of tight glycemic control, while well established in human diabetic patients have not been demonstrated in dogs and cats; although theoretically better glycemic control should result in fewer diabetic complications such recurrent infection, proteinuria, and cataract formation. The goals of diabetic regulation should therefore, take into account the lifestyle of the owner, the presence of concurrent

Insulin Glargine (Lantus) Glargine insulin is a long acting insulin analogue that is also used for treatment of diabetes mellitus in cats. The pharmacokinetics of insulin glargine are very similar to that of PZI although the time to insulin nadir is longer. In a study of 13 diabetic cats fed a commercial high protein low carbohydrate diet and treated with either once daily Glargine insulin at a dose of 0.5 U/kg once a day, or lente insulin (human recombinant) 0.5 U/ kg, twice a day, there was a significant improvement in both groups of cats and no difference was detected in glycemic control between the two insulin groups. Of the four cats in remission at the end of the study, 3 had been treated with lente insulin and one with glargine. In a study of 24 newly diagnosed diabetic cats, treated with glargine, PZI, or Lente, and fed a low carbohydrate, high protein diet, glargine treated cats tended to have lower blood glucose concentrations and fructosamine concentrations than those treated with PZI or Lente. In this study there was a higher rate of diabetic remission rate in the cats treated with Glargine insulin than in the cats treated with PZI or lente insulin. In a study of 90 cats with diabetes mellitus, 29 cats were treated with glargine insulin and 21 (72%) went into diabetic remission. The starting dose for insulin in a new feline diabetic patient is 0.25 – 0.5 Unit/kg or 1-3 U/cat. It is recommended that PZI and Glargine insulin are both started at the lower end of this dose. It is difficult to predict in advance

illness, the age of the patient, and the practicality of tight glucose monitoring. Ideally the blood glucose should be maintained between 100 to 200 mg/dl, however most patients will have some blood glucose concentrations that fall outside this range and most patients are clinically well regulated if most of the blood glucose concentrations are less than 300 mg/dl. Occult hypoglycemia is an important cause of poor glycemic control and can lead to unnecessary visits to the emergency clinic. The insulin dose should be decreased if the blood glucose falls below 80 mg/dl on the BG curve. It is important to remember that it is difficult to assess the duration of insulin action if the glucose nadir is in the hypoglycemic range because this can lead to release of counter-regulatory hormones such as glucagon which drives the blood glucose back up prematurely. (continued)

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