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)
2 DIAGNOSIS The diagnosis of DM is made based on characteristic clinical signs of diabetes mellitus (polyuria, polydipsia, polyphagia, and weight loss), and documentation of hyperglycemia and glucosuria. In cats the diagnosis may be complicated by stress hyperglycemia. When making a diagnosis of DM in cats, it is therefore important not only to document persistent hyperglycemia and glucosuria, but also to rule out other diseases that may cause similar clinical signs such as hyperthyroidism and gastrointestinal disease. Measurement of fructosamine concentrations or urine glucose concentration of samples collected in the home environment may allow the clinician to distinguish between stress induced hyperglycemia, and persistent hyperglycemia due to diabetes mellitus. Measurement of fructosamine is unreliable for cats with concurrent hyperthyroidism because increased protein turnover decreases fructosamine concentration. Glucosuria may also occur secondary to ketamine anesthesia, chronic renal failure, and post-obstructive diuresis so is not on its own diagnostic for diabetes mellitus. The presence of significant ketonuria and concurrent hyperglycemia is diagnostic for diabetes mellitus. Cats are also unique in that DM in this species may go into remission. Up to 70% of diabetic cats have been reported to go into spontaneous clinical remission, with good glycemic
control. Unfortunately, the glucagon tolerance test is not useful in predicting whether or not a cat is likely to go into diabetic remission. 3 INSULIN THERAPY Classification of insulin: It is very important for clinicians prescribing insulin to understand the characteristics of the different products that are commercially available. Insulin may be classified by insulin source, insulin formulation, or duration of action. Product availability has changed over the last few years.
Insulin formulations that are currently available include short duration regular insulin (designated R), moderate duration NPH insulin (designated N), moderate duration Lente insulin (designated L), and long duration PZI insulin. Insulin may be derived from bovine, porcine, or human recombinant sources and the concentration may be either 100 units/ml (human products) or 40 units/ml (veterinary products). A number of human recombinant insulin analogues are also available. The insulin products that are currently commercially available in the US are listed below.
INSULIN PRODUCTS CURRENTLY AVAILABLE COMMERCIALLY AND USED IN CATS AND DOGS SHORT ACTING Regular insulin (Zinc insulin crystals) Products: Humulin R [Lilly], Novolin R [NovoNordisk] Both human recombinant (100 U/ml) MODERATE ACTING NPH insulin (neutral protamine hagedorn) Products: Humulin N [Lilly], Novolin N [NovoNordisk] Both human recombinant (100 U/ml) Lente insulin (65% crystalline and 35% amorphous) Product Vetsulin (Merck) pork (40 U/ml) LONG ACTING PZI insulin Insulin complexed with protamine and zinc. Product: ProZinc [Boehringer Ingelheim] human recombinant (40 U/ml) Glargine Insulin analogue Products: Lantus [Sanofi-Aventis], human recombinant (100 U/ml) Detemir Insulin analogue Products: Levemir [NovoNordisk], human recombinant (100 U/ml)
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