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)

4 DIABETIC REMISSON A unique feature of diabetes mellitus in cats is that some diabetic cats become non-insulin dependent after treatment has been initiated. From 15 to 70 % of cats with DM, have been reported to go into spontaneous clinical remission after initiation of insulin treatment. This is termed diabetic remission. Diabetic remission is typically defined as euglycemia that persists for greater than 4 weeks without the use of exogenous insulin. The duration of remission is variable with some cats requiring insulin treatment again within a few weeks to months and other cats remaining in remission for months to years. Influence of diet It has been proposed that low carbohydrate diets increase the chance of diabetic remission in newly diagnosed diabetic cats. A prospective study comparing a low carbohydrate-low fiber diet to a moderate carbohydrate-high fiber diet in 63 diabetic cats showed improvements in glycemic control in both groups, but there was a higher rate of remission of diabetes mellitus in the low carbohydrate-low fiber diet. These findings support the clinical opinion that low carbohydrate diets in conjunction with good glycemic control increase the likelihood of diabetic remission. If diabetic remission occurs in cats it is most commonly in the first few months of treatment. Influence of insulin It has been shown that strict glycemic control is important in achieving diabetic remission and it is clear that

diabetic cats can go into remission with any insulin if good glycemic control is achieved. Most cats have better glycemic control with long acting insulin (PZI or Glargine) so most clinicians recommend these insulin formulations as the insulin products of choice in diabetic cats. Other factors Other factors that have been documented to increase the likelihood of diabetic remission in cats include short duration of diabetes mellitus (< 180 days), administration of glucocorticoids prior to diagnosis, low insulin dose required to achieve glycemic control, and lack of polyneuropathy. Age, sex, body weight, presence of renal failure, presence of hyperthyroidism, or presence of obesity at diagnosis have not been shown to influence the likelihood of remission. Serum concentrations of glucose, fructosamine, insulin, glucagon, and insulin growth factor I are not different between cats that do and do not achieve remission, but cats achieving remission have a higher glucagon to insulin ratio.

REFERENCES 1. Bennett N, Greco DS, Peterson ME, et al. Comparisons of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus. J Fel Med and Surg 2006;8:73-84 2. Marshall RD, Rand JS, Morton JM. Treatment of newly diagnosed diabetic cats with Glargine insulin improves diabetic control and results in higher probability of remission than protamine zinc and lente insulins. J Fel Med Surg 2009;11:683-689. 3. Nelson RW, Lynn RC, Wagner-Mann CC, et al. Protamine zinc insulin for treatment of diabetes mellitus in cats. J Am Vet Med Assoc 2001;218:38-42. 4. Nelson RW, Henley K, Cole C. Field safety and efficacy of protamine zinc recombinant insulin for treatment of diabetes mellitus in cats. J Vet Intern Med 2009;23:787-793. 5. Roomp K, Rand J. Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with Glargine. J Fel Med Surg 2009;11:668-682 6. Zini E, Hafner M, Osto M. et al. Predictors of clinical remission in cats with diabetes mellitus. J Vet Intern Med 2010;24:1314-1321.

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