Feline Diabetes Mellitus

Question 1

What type of cats are at increased risk?

Answer 1

Older, indoor, male cats

Question 2

What are the causes of DM in cats?

Answer 2

Sustained insulin resistance
Secondary to chronic pancreatic disease
Dietary influences

Question 3

What cat breeds are predisposed to DM?

Answer 3

European and Australian Burmese cats

Question 4

What causes insulin resistance in cats?

Answer 4

Obesity
Lack of exercise and poor muscle mass
Endocrinopathies
Drugs
Inflammatory conditions

Question 5

How does obesity cause DM in cats?

Answer 5

4x increased risk
Number 1 cause of insulin resistance
Related to adipokines produced by fat cells
Inflammatory condition

Question 6

What endocrinopathies contribute to DM in cats?

Answer 6

Hypercortisolism
Hyperthyroidism
Acromegaly

Question 7

How does acromegaly cause DM in cats?

Answer 7

Growth hormone secreting pituitary tumor
GH is a very powerful antagonist to insulin

Question 8

What drugs can cause DM in cats?

Answer 8

Glucocorticoids (prednisolone, DepoMedrol) and progestagens (Megestrol acetate)

Question 9

How do inflammatory conditions cause DM in cats?

Answer 9

Cytokines antagonize the effect of insulin

Question 10

How do inflammatory conditions cause DM in cats?

Answer 10

Cytokines antagonize the effect of insulin
Chronic inflammation

Question 11

How does a poor diet cause DM in cats?

Answer 11

Incretins - specifically GLP1 have powerful trophic effects on beta cells
The best stimuli for the incretins in cats are fats and proteins
High carb diets are BAD
Diets with <14% of ME from carbs are recommended

Question 12

How does insulin resistance occur?

Answer 12

More insulin is needed to get the job done
Amylin is co-secreted with insulin
Amylin is poorly soluble and gets stuck in the pancreas
Results in pancreatic amyloidosis
Causes progressive compromise to beta cell function

Question 13

What BG causes glucose toxicity?

Answer 13

> 200 mg/dl

Question 14

What happens when BG goes >200 mg/dl?

Answer 14

Diabetic neuropathy
Apoptosis of beta cells

Question 15

What happens when BG goes >250 mg/dl?

Answer 15

Pu/pd

Question 16

What is the renal glucose threshold in cats?

Answer 16

250 mg/dl

Question 17

What are the clinical signs of DM in cats?

Answer 17

Polyuria
Polydipsia
Polyphagia
Weight loss
Diabetic neuropathy
Causes of insulin resistance

Question 18

Does hyperglycemia in a cat = diabetes mellitus?

Answer 18

No, need to prove a persistent hyperglycemia

Question 19

What would you see in a urinalysis of a DM cat?

Answer 19

Glucosuria
Can have ketonuria
Often concentrated urine despite sever pu/pd
Could have UTI

Question 20

What would you expect to see on a chemistry of a DM cat?

Answer 20

Hyperglycemia
Hypercholesterolemia
Hypertriglyceridemia
Hyponatremia

Question 21

What is a serum fructosamine measurement for?

Answer 21

Amount of fructosamines is proportional to BG levels
Allows us a look back over the previous 1-2 weeks
Amounts are lowered by diseases that impact albumin turnover
Be careful for Somogyi overswing

Question 22

What is the #1 goal of treatment?

Answer 22

A satisfied owner

Question 23

What are suitable first choice insulins for cats?

Answer 23

Insulin glargine and PZI

Question 24

What is the starting dose of insulin for cats?

Answer 24

1 unit/cat BID or 0.25 U/kg

Question 25

What is the best option for monitoring?

Answer 25

BG measurements at home

Question 26

What is the Somogyi overswing?

Answer 26

Super low glucose, body causes glucose to skyrocket for about a day Will miss a super low if using fructosamine - will show a high average

Question 27

Why is measurement of water intake unreliable?

Answer 27

BG generally >250 mg/dl before polydipsia occurs

Question 28

How should you go about adjusting the insulin dose?

Answer 28

Nadir <80 mg/dl = decrease the dose by 25-50% BG 80-250 mg/dl all day = keep dose Nadir >150 mg/dl = increase dose by 1/2 unit Cat should be showing signs indicating hyperglycemia Allow several days to see effect before increasing again

Question 29

What option might be effective when used once daily in cats and why?

Answer 29

Insulin glargine U-300 Strong concentration slows release from the SQ space

Question 30

What does SGLT-2 inhibitor do?

Answer 30

Prevent glucose uptake by the renal tubules Lowers BG via urine loss

Question 31

When does remission most often occur?

Answer 31

Within the first 90 days

Question 32

What cats are unlikely cats for remission?

Answer 32

Steroid dependent Chronic disease Dietary issues Peripheral neuropathy