Veterinary Medicine - June 2008 - (Page c16)

Figure 2. Initial blood glucose curve Two units of glargine were administered at time 0. Blood glucose concentration (mg/dl) 120 100 80 60 117 48 40 40 30 24 29 31 20 0 0 2 4 6 8 10 12 14 Hours after insulin injection renal insu ciency, pancreatitis, neoplasia, hyperadrenocorticism, acromegaly, and hyperlipidemia are also recognized as causing insulin resistance.1,4,11 In addition, obesity can be the sole cause for insulin resistance.4 It is essential that you perform the necessary diagnostic tests. In one study, 12% of diabetic cats (7 out of 57) had bacterial urinary tract infections, based on a urine culture.14 Interestingly, only two of those seven cats showed signs consistent with lower urinary tract disease, and only ve had bacteria in the urine sediment. This emphasizes the importance of performing routine urine cultures, regardless of glycemic control. Regulating newly diabetic cats can be challenging for many reasons, especially with concurrent in ammatory disease. Other common reasons include poor patient cooperation and client compliance. One of my most challenging cases involved all of these factors. Case study Scamper, a 14-year-old spayed female domestic shorthaired cat, was presented to my hospital for her routine annual physical exam. The client casually mentioned 16 that she had noticed Scamper drinking more water, compared with her other cats. The physical exam was unremarkable except for grade 3 out of 4 dental disease—which I later expected would present a challenge in attaining glycemic control—as well as a dull coat with dander. This formerly obese cat (body weight of 13.4 lbs one year earlier) was now thin and weighed only 10.7 lbs. I performed a serum biochemical pro le, an electrolyte panel, a complete blood count with a di erential, and a complete urinalysis. Heartworm antibody, feline leukemia virus antigen, and feline immunode ciency virus antibody tests were negative. I did not obtain a pretherapy serum fructosamine concentration or radiographs. Abnormal biochemical results are listed in Table 1 (page 14). Scamper was known to be fractious. In addition, the client was unable to perform an ear prick at home. Faced with these challenges, I initiated treatment with insulin glargine, hoping that Scamper would quickly go into remission. I started insulin glargine at 0.5 U/kg (two units) subcutaneously every 12 hours. I instructed the client to watch the cat closely over the next two weeks for a decrease in water consumption and to schedule a blood glucose curve at that time. With eight other cats, the client admitted di culty knowing what volume of urine was produced or water consumed by any individual cat.The only reason she noticed polydipsia initially was because she began to see Scamper at the water bowl multiple times daily, which she had never previously witnessed. Scamper also drank a larger volume of water relative to the other cats. Three weeks after initiating insulin, the client, paying closer attention to Scamper, had not observed any di erence in her thirst, or perceived urine production (based on the collective amount of urine). On

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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