Veterinary Medicine - June 2008 - (Page c14)

Table 1. Abnormal laboratory results before initiating insulin Parameter Glucose Urea nitrogen ALT AST Total T4 Results 552 mg/dl 38 mg/dl 171 U/L 141 U/L 0.8 µg/dl Normal reference range 64 to 170 mg/dl 14 to 36 mg/dl 10 to 100 U/L 10 to 100 U/L 0.8 to 4.0 µg/dl Negative opportunity to determine the true status of a diabetic cat, especially if you make it fun and educational for the client. However, remember that this process can become overwhelming, even for carefully chosen clients, and you must be sensitive to their needs and the cats’ needs. Other monitoring methods Additional methods of monitoring diabetic cats include client observation and the testing of urine glucose, serum fructosamine, and glycosylated hemoglobin levels. Client observation. Teaching clients to observe notable parameters is but one of the many tools used to monitor diabetes. It is the most important tool if you use glargine insulin because of the rapid (within one week) and dramatic decrease in water consumption, possibly correlating to hypoglycemia.1 As the cat becomes regulated, the client should notice a return to normal water consumption (less than 80 ml/kg every 24 hours),2 less urine in the litter box, less hunger, and an increase in—or stabilization of—body weight. In my experience, the cat also acts more like its old self and is more even-tempered, both at home and in the hospital. It is often helpful for the client to record these parameters in a daily journal. By stressing the importance of observation, clients can quickly identify changes and alert their veterinarian. Urine glucose. It’s important for clients to follow urine glucose and ketone concentrations at home every one to two weeks.The renal glucose threshold in cats ranges from 220 to 300 mg/dl.1 Most well-controlled diabetic cats will have trace or 1+ glucose in their urine. If urine glucose is negative for 48 hours, the cat may be in remission.1 In my opinion, if ketones, at any level, are present, the client should seek medical attention.The dose of insulin should never be adjusted based solely on Urine glucose 3+ stress. During other curves, blood glucose concentrations may be deceivingly low, presumably because the cat would not eat while hospitalized. These cats need glucose or dextrose supplementation and leave us questioning the reason for the low blood glucose concentrations—is it because they did not eat, or is the insulin dose too high? In-home blood glucose curves In-home blood glucose curves have become more popular in recent years because of the premise that they are less stressful to cats. The validity of these blood glucose curves is solely dependent on the client’s ability to accurately and gently obtain the blood sample. In one study, the blood glucose concentrations for the same group of cats were actually higher at home than in the hospital, possibly because of client-induced stress or the cats’ improved appetite at home.3 Careful client selection and training are crucial to the success of in-home monitoring.3 You must ensure that the client understands the optimal blood glucose range and how to respond when values are outside the range (they will know how to respond after consulting with a veterinarian). I believe that in-home monitoring o ers the best 14

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.