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Managing uncomplicated diabetes

Starting regulation

Two types of patients can be categorized as uncomplicated:

  1. Cats presented after the owner notes the appearance of clinical signs without general deterioration or diabetic ketoacidosis (DKA). These are non-emergency cases.
  2. Cats that have stabilized after initial presentation with and successful treatment for DKA.

During consultation:

  • Perform a thorough examination and weigh the patient.
  • Evaluate laboratory test results including complete blood count, urinalysis (including sediment examination), and serum biochemistry profile (including T4).
  • Photograph patient’s head and whole body; optional but often the only way to diagnose subsequent acromegaly.
  • Rule out hyperthyroidism, renal failure, inflammatory bowel disease, pancreatitis and exocrine pancreatic insufficiency, hyperadrenocorticism, acromegaly, neoplasia, or hepatic disease.

When health status is known and diabetes mellitus confirmed:

  • Thoroughly explain to cat owner what diabetes mellitus is, that achieving regulation may take up to 2 months, and what the implications are for the family. Make sure the owner understands the treatment involved, and that the cat should be able to live a happy, healthy life with consistent treatment. This is crucial, as complete cooperation of the owner is essential to treatment success.
  • Treat existing infections or other medical conditions. Any disease will affect insulin metabolism.
  • Introduce appropriate diet.
  • Begin treatment with Vetsulin® (porcine insulin zinc suspension).

Starting Vetsulin

In-clinic:

  • Weigh the cat to obtain a benchmark for future weight gain or loss.
  • Start the cat on 1 to 2 IU injections of Vetsulin given twice daily at 12-hour intervals. Administer injections concurrently with or right after meals for cats fed twice daily. No change in feeding schedule is needed for cats fed ad libitum.
  • Hospitalize the cat for the day to verify that the starting dose does not cause hypoglycemia.
  • Instruct owner on:
    • How to administer injections.
    • How to identify and treat hypoglycemia.
    • Parameters to monitor at home.
    • Preferred diet and frequency of meals.
  • Discharge cat to owner’s care for 2 to 4 weeks. This allows the cat and owner to acclimate to the injection regimen.

At home, have the owner:

  • Monitor and record water and food consumption.
  • Monitor and record urine glucose and/or ketone bodies.
  • Maintain starting dose and frequency of administration for 1 to 2 weeks, unless there’s evidence of hypoglycemia.
  • Bring the cat in for re-evaluation 2 to 4 weeks after starting Vetsulin treatment.

In-clinic re-evaluation:

  • Verify adequate injection technique.
  • Evaluate owner's monitoring of clinical signs and glycosuria.
  • Weigh the patient.
  • Evaluate glycemia via glucose curve or punctual blood glucose evaluations.
  • Increase insulin dose if necessary, according to clinical signs and glycemia values. An interval of 2 to 4 weeks between dosage increments is ideal (unless there’s evidence of hypoglycemia).

Regulation:

  • Repeat procedures listed above at regular intervals until clinical signs and weight are satisfactory.
  • When regulation is achieved (no clinical signs; satisfied owners), schedule rechecks every 2 to 4 months:
    • Perform a complete physical examination.
    • Revise home monitoring if necessary.
    • Evaluate glycemia if necessary (eg, glucose curve, fructosamine).

If there is a problem:

If clinical signs resume, fructosamine levels are not satisfactory or overall health deteriorates, causes must be identified.

  • Perform a complete physical exam.
  • Recheck:
    • Injection technique and insulin quality control.
    • Feeding and exercise.
    • Environment of the patient (recent changes).
  • Perform a glucose curve.
  • Evaluate complete blood count, urinalysis (including sediment examination), and serum biochemistry profile (including T4).

Additional testing procedures may be required. Diabetic cats may develop other concurrent diseases or infections that will interfere with insulin.

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