Managing chronic diseases in cats - DVM
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Managing chronic diseases in cats
Help your feline patients live longer, healthier lives.


DVM Best Practices


Your weight management plan should include suggestions for improving exercise by enriching the cat's environment. Food puzzles are toys that release small amounts of dry food as the cat plays, and they are a great way to provide a more stimulating environment and encourage cats to be more active. For more examples, visit the Ohio State University College of Veterinary Medicine's Indoor Cat Initiative Web site at http://www.nssvet.org/ici/index.php/.

Diabetes mellitus Diabetes mellitus is the second most common endocrinopathy in cats after hyperthyroidism, affecting about one in 200 to 300 cats.5 The typical diabetic cat is middle-aged to senior, obese, and a neutered male. As we learn more about the nutritional management of diabetes mellitus and advances in insulin therapy and monitoring, we can better treat these patients.

Recent research has shown that a high-protein, low-carbohydrate diet similar to the cat's natural diet of mice may help control diabetes mellitus.5 Diabetic cats receiving low-carbohydrate diets were 10 times more likely to be able to discontinue insulin therapy than cats fed high-fiber diets in one study.6 Cats are obligate carnivores, and, as such, are not metabolically adapted to diets containing an excess of carbohydrates.5 Diets rich in carbohydrates may worsen hyperglycemia in diabetic cats and even cause protein wasting. Appropriate diet options for diabetic cats include canned kitten foods or newer therapeutic diets formulated for diabetic cats, such as Purina Veterinary Diets DM Diabetes Management and Royal Canin Veterinary Diet Diabetic DS 44.

Many insulins have been available over the years to manage feline diabetes. None have proved ideal for a variety of reasons, including inadequate duration of action, poor absorption, and variable patient response. Common insulin choices include NPH (Humulin N—Eli Lilly), protamine zinc (PZI Vet—IDEXX Laboratories), and porcine zinc insulin (Caninsulin—Intervet, available in Canada, and Vetsulin—Intervet, available in the United States).

Glargine (100 U/ml ) (Lantus—Aventis), a human synthetic insulin analogue, offers a new option. It's marketed for people as a long-acting, peakless insulin and it has a shelf life after opening of six months when refrigerated. Evaluations of the pharmacokinetics and pharmacodynamics have shown that glargine has a long duration of action and predictable blood glucose-lowering ability in diabetic cats.7

Start newly diagnosed diabetic cats on glargine at 0.5 U/kg subcutaneously every 12 hours and hospitalize them for the first two or three days of therapy.8 Perform daily blood glucose curves and obtain blood samples every four hours during hospitalization. Most cats' blood glucose levels will decrease substantially within three to five days, and they will need their glargine dosage reduced within two weeks. Reports of cats exhibiting clinical signs of hypoglycemia have been rare with this insulin. Cats fed a high-protein, low-carbohydrate diet and treated with insulin glargine have an excellent chance of diabetes remission within four months.9 Insulin glargine offers a promising new tool for treatment of feline diabetes mellitus and may become the insulin of choice as North American practitioners gain experience with its use.


Figure 2. A portable blood glucose meter and a drop of blood from an ear vein can be used to measure cats' blood glucose concentrations at home.
Blood glucose curves are essential in managing feline diabetes, yet cats may be stressed during hospitalization, making it difficult to interpret results. One solution is to teach clients how to perform blood glucose curves at home using capillary blood sampling from the ear and a portable blood glucose meter (Figure 2). http://VeterinaryPartner.com/ offers an excellent client resource for home blood glucose monitoring, including a video demonstration.

Home blood glucose curves offer substantial benefits for veterinarians, patients, and owners. Evaluation of cats monitored with home blood glucose curves has shown that owners appreciate home blood glucose curves because they avoid the stress of hospitalization for their cats.10 In addition, cats are re-examined just as often, and owners aren't prone to changing insulin doses without consultation. In almost 40% of cases, home-based blood glucose curves suggested a different treatment plan than blood glucose curves performed at the hospital.11


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