Veterinary Medicine - June 2008 - (Page c17)

Monitoring diabetes mellitus in diabetic cats my recommendation, the client brought Scamper into the clinic for a blood glucose curve. Scamper was given two units of insulin at 6 a.m., so a time 0 blood glucose value was not obtained. Blood glucose values were obtained over the next 12 hours (Figure 2, page 16). The values in the curve startled me, and I administered 5 cc of Karo syrup orally after evaluating each blood glucose test result. This likely contributed to the 12 hour value of 117 mg/dl.Was the insulin dose too high, or had Scamper gone into remission? I discharged her and discontinued the insulin. Three days later, Scamper’s blood glucose during her curve was between 250 to 300 mg/dl. Consequently, I restarted insulin at one unit every 12 hours. Two weeks later, a blood glucose curve was performed over a 12.5-hour period, minus a time 0 blood glucose value. (Figure 3). Scamper did not eat well in the hospital and was given 5 cc of Karo syrup orally at time 12 hours. Based on the glucose values obtained, I felt certain that Scamper was now in remission and discontinued the insulin. One month later, the client again witnessed Scamper drinking a large volume of water.Two blood glucose samples, at 10 a.m. and 1 p.m., were obtained.The values were 388 mg/dl and 571 mg/dl, respectively. Her serum fructosamine concentration was 489 µmol/L. Scamper was started back on 0.5 units of insulin glargine every 12 hours.Two weeks later, the cat’s blood glucose curve remained relatively at, ranging from 453 mg/dl to 520 mg/dl. Consequently, I increased the dose to one unit every 12 hours. Three weeks later, another blood glucose curve was performed.The glucose concentration never decreased below 300 mg/dl and was 464 mg/dl at its highest. Scamper’s insulin dosage was increased to two units every 12 hours. Three weeks after the increase to 2 U twice a day, the client was no longer seeing Figure 3. Follow-up blood glucose curve One unit of glargine was administered at time 0. Blood glucose concentration (mg/dl) 140 130 120 100 80 60 40 20 00 2 4 6 8 10 12 14 120 88 84 88 73 64 95 Hours after insulin injection Scamper at the water bowl, and the cat’s behavior seemed normal. A blood glucose curve was performed at that time (Figure 4, page 18).We concluded that the blood glucose concentration nadir (60 mg/dl) was falsely low because the cat stopped eating while in the hospital.We also concluded that the length of time to the nadir (eight hours) was accurate because insulin glargine is known to have a slower onset of action than short- or intermediate-acting insulins.1 Three weeks after this curve, Scamper’s serum fructosamine concentration was 401 µmol/L, which suggested fair glycemic control. It took four months to attain minimally acceptable glycemic control in this patient. In retrospect, after two months without approaching optimal regulation, I should have changed the insulin to protamine zinc insulin or lente insulin (Vetsulin—Intervet) to attain better glycemic control. In addition, the cat’s concurrent dental disease, which was later eliminated, most likely contributed to the di culty in interpreting the monitoring parameters and in achieving regulation. Scamper subsequently became more fractious—and the client more anxious— with each visit to the hospital, even for routine exams. Because of this and my 17

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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