Veterinary Medicine - June 2008 - (Page c11)

Porcine insulin zinc suspension in the management of feline diabetes mellitus about two-thirds of diabetic cats and clinical remission in about one- fth of patients.3,4,6,12 These numbers increase considerably if appropriate dietary management is initiated.13-15 Table 2. Vetsulin therapy in diabetic cats Starting dose 1 to 2 U per cat every 12 hours Ongoing management A satisfactory dose is achieved when clinical signs are eliminated or improved to the satisfaction of the owner, the cat is maintaining or attaining an appropriate weight, and physical examination ndings, blood glucose and fructosamine values are acceptable. For cats fed ad libitum, no change in feeding schedule is needed.These cats should be re-evaluated at appropriate intervals and the dose adjusted based on clinical signs and biochemical con rmation of the level of glycemic control (e.g., blood glucose, fructosamine, urinalysis results). Fructosamine values, which re ect the average blood glucose concentration during the preceding two to three weeks, are often used to con rm that glycemic control is adequate. Fructosamine values above 550 µmol/L indicate that the diabetes is poorly controlled.11,16,17 The insulin dose may need to be adjusted further when the cat’s diet, body weight, or concomitant medication changes or if the cat develops a concurrent infection, in ammation, neoplasia, other endocrine disorder, or other medical conditions. In diabetic cats, indicators of good glycemic control are the resolution of clinical signs, following a reduction in mean blood glucose concentration to below the renal threshold for glucose (around 300 mg/dl) combined with a blood glucose nadir between 80 and 200 mg/dl.11,16,17 In other words, a blood glucose curve that demonstrates that hyperglycemia is absent for the majority of the inter-dosing interval and hypoglycemia are avoided. The lower dose (1 U every 12 hours) is often used for cats with blood glucose concentrations before treatment of < 360 mg/dl.3,4,6 The higher dose (2 U every 12 hours) is at times used for cats with blood glucose concentrations before treatment of ≥ 360 mg/dl. 3,4,6 ACVIM Forum 2007. Available at: www.vin.com/ acvim/2007. Accessed March 6, 2008. 3. Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: ndings during the rst week and after 5 or 9 weeks of therapy. J Feline Med Surg 2001;3:23-30. 4. Martin GJ, Rand JS. Control of diabetes mellitus in cats with porcine insulin zinc suspension. Vet Rec 2007;161: 88-94. 5. Vetsulin Freedom of Information Summary. NADA 141-236. 6. Michiels L, Reusch CE, Boari A, et al. Treatment of 46 cats with porcine lente insulin – a prospective, multicentre study. J Feline Med Surg 2008;10:in press. 7. Haines DM. A re-examination of islet cell cytoplasmic antibodies in diabetic dogs. Vet Immunol Immunopathol 1986;11:225-233. 8. Schnabel CA, Fineberg SE, Kim DD. Immunogenicity of xenopeptide hormone therapies. Peptides 2006;27: 1902-1910. 9. Hoenig M, Reusch C, Peterson ME. Beta cell and insulin antibodies in treated and untreated diabetic cats. Vet Immunol Immunopathol 2000;77:93-102. 10. Adams JP, Catchpole B. Prevalence of anti-insulin antibodies in insulin-treated diabetic cats, in Proceedings. Br Sm Anim Vet Assoc Cong 2008;486-487. 11. Feldman EC, Nelson RW. Feline diabetes mellitus. In: Canine and Feline Endocrinology and Reproduction. 3rd ed. St Louis, MO: Saunders, 2004;539-579. 12. Goossens MM, Nelson RW, Feldman EC, et al. Response to insulin treatment and survival in 104 cats with diabetes mellitus (1985-1995). J Vet Intern Med 1998; 12:1-6. 13. Bennett N, Greco DS, Peterson ME, et al. Comparison of a low carbohydrate-low ber diet and a moderate carbohydrate-high ber diet in the management of feline diabetes mellitus. J Feline Med Surg 2006;8:73-84. 14. Mazzaferro EM, Greco DS, Turner AS, et al. Treatment of feline diabetes mellitus using an alpha-glucosidase inhibitor and a low-carbohydrate diet. J Feline Med Surg 2003;5:183-189. 15. Weaver KE, Rozanski EA, Mahonay OM, et al. Use of glargine and lente insulins in cats with diabetes mellitus. J Vet Intern Med 2006;20:234–238. 16. Rand JS, Martin GJ. Management of feline diabetes mellitus. Vet Clin North Am Small Anim Pract 2001;31: 881-913. 17. Martin GJ, Rand JS. Comparisons of different measurements for monitoring diabetic cats treated with porcine insulin zinc suspension. Vet Rec 2007;161:52-58. References 1. Sanger F. The chemistry of insulin. In: Nobel Lectures, Chemistry, 1942-1962. Amsterdam: Elsevier, 1964;544-556. 2. Abrams-OGG ACG. Chemistry and pharmacology of therapeutic insulin preparations, in Proceedings. 25th 11 http://www.vin.com/acvim/2007 http://www.vin.com/acvim/2007

Table of Contents Feed for the Digital Edition of Veterinary Medicine - June 2008

Veterinary Medicine - June 2008 Contents Leading Off Clinical Exposures Idea Exchange A Challenging Case: Conjunctival Lymphoma in a Cat Updates on Canine Hypoadrenocorticism Product Preview CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller Clinical Edge - June 2008 Table of Contents Managing Diabetes Mellitus in Cats: What Makes it Work? Porcine Insulin Zinc Suspension in the Management of Feline Diabetes Mellitus Monitoring Diabetes Mellitus in Diabetic Cats Feline Diabetes Mellitus: Important Client Communication Points

Veterinary Medicine - June 2008

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