Veterinary Medicine - June 2008 - (Page c6)

Table 2. Complications of unregulated diabetes mellitus Common functional changes associated with unregulated feline diabetes mellitus include: • Polyphagia and weight loss • Hyperglycemia • Polyuria and polydipsia • Damaged peripheral motor and sensory nerves of the limbs • Pulmonary changes, such as congestion and edema, histiocytosis, pneumonia, smooth muscle hypertrophy, ﬁbrosis, mineralization, neoplasia, and type II pneumocyte hyperplasia • Acromegaly • Increased islet amyloid polypeptide deposition. individual patient’s blood glucose. Based on my mostly successful management of feline diabetics, I personally believe that cats should have free access to higher-protein, low-carbohydrate food all the time—rather than feeding twice daily—because this re ects more closely the natural feeding behavior and, hence, insulin secretion of cats. Follow-up care After making the diagnosis, we teach our clients about what is happening in their cat’s body and why they are seeing the changes (polyuria, polydipsia, polyphagia, and weight loss).Then we teach them to record in a diary their observations of these clinical signs needed for evaluation of progression or resolution of the condition, such as thirst and urine volume. At the same time, we schedule a follow-up appointment two weeks later for a blood glucose curve.Tell the client to expect daily calls from the hospital during the three to four days following diagnosis for support and questions.The calls also serve as a follow-up on the cat’s condition and helps sta ascertain that the client is keeping the clinical signs observation diary. 6 At the rst appointment for a blood glucose curve, we take hourly measurements, adjust the insulin dose as indicated, discuss the diary notations and trends with the client, and teach them how to measure glucose by ear prick. At this time, I want them to learn to be comfortable with this technique. After the subsequent, two week, in-clinic blood glucose curve, we ask them to perform the curves at home and report the results to us for dose adjustment and discussion. Avoid spot checking blood glucose concentrations because they can be misleading and mask the Somogyi e ect. The exception to this would be the clients spot checking blood glucose concentrations at home if their cat “doesn’t look right” before deciding whether to give insulin. Monitoring a diabetic cat using only serum fructosamine concentrations without blood glucose curves will also miss the Somogyi e ect and, because the fructosamine will be elevated in these cats, can result in a life-threatening, incorrect therapeutic decision to increase the insulin dose. I do not routinely ask clients to monitor urine glucose or ketones at home because even well-regulated cats may have some glucosuria. However, justi ed occasions to monitor urine parameters at home include: • To help provide more information when trying to sort out discrepancies in glucose values and clinical ndings (e.g., an acceptable blood glucose curve but polyuria/polydipsia and weight loss still present) • To identify when or if glucosuria recurs in cats with transient diabetes • To determine if glucosuria resolves in cats on oral hypoglycemics • To monitor for ketones in previously or currently ketoacidotic cats. During the month or two following diagnosis, by performing and evaluating blood glucose curves, measuring serum

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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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