Veterinary Medicine - September 2007 - (Page 602)

Diabetes management O P E E R - R E V I E W E D polydipsia must be documented. In equivocal cases, measuring the serum fructosamine concentration (which reflects serum glucose levels for the previous three weeks) may be necessary. Alternatively, diagnostic litter additives (e.g. Glucotest—Nestlé Purina) can be used to document persistent glycosuria in the home environment. Unless a cat fusion then exacerbate the situation. Once diabetic ketoacidosis is established, aggressive in-hospital care becomes necessary, but this is beyond the scope of this article. Because glucose is a nutrient source for microorganisms, many diabetic patients present for evaluation of bacterial urinary tract infections. It is impor- tions. In dehydrated or anorectic patients, these parameters need close monitoring, and supplementation is necessary to prevent precipitous decreases as insulin is introduced. Complete blood count A diabetic patient that seems otherwise healthy is expected to have normal complete blood count results. Anemia (which may be masked by dehydration) or leukocytosis should prompt further investigation. Failure to recognize concurrent problems will affect the patient’s response to therapy. is ketoacidotic, insulin therapy should not be started without clear evidence of persistent hyperglycemia. tant to remember that severe polyuria may make it difficult to identify bacteria and white blood cells on a urine sediment examination. A urine culture with antimicrobial sensitivity testing is always indicated, but start appropriate antibiotics immediately if infection is suspected. Thyroid evaluation Screen all cats over 6 years of age for hyperthyroidism by measuring a total thyroxine (T4) concentration. If the concentration is at the upper end of the normal range, early hyperthyroidism may be more readily identified by measuring the free T4 concentration by equilibrium dialysis.3 Dogs with untreated diabetes may have low total T4 concentrations because of euthyroid sick syndrome. So evaluate a free T4 concentration and thyroid-stimulating hormone concentration before starting thyroid supplementation. INITIAL DATABASE Once diabetes mellitus has been confirmed, certain tests are indicated to direct appropriate therapy and to check for concurrent disease. Many patients are presented to their veterinarian after many weeks of hyperglycemia, and it is often an acute complication, such as pancreatitis or a urinary tract infection, that prompts the owner to seek help. Failure to recognize concurrent problems will affect the patient’s response to therapy and may ultimately affect the outcome. Serum chemistry profile Concurrent problems, such as renal failure, pancreatitis, and hyperadrenocorticism, can profoundly affect a patient’s response to insulin. A serum chemistry profile is necessary to identify other diseases and to provide a baseline for future comparison. Closely evaluate markers for dehydration, such as azotemia or hyperproteinemia, and provide fluid therapy if necessary. Serum cholesterol and triglyceride concentrations may be elevated as a result of the diabetes but can also suggest concurrent thyroid or adrenal dysfunction. The serum sodium concentration is often decreased in response to glucose-related hyperosmolality; this hyponatremia does not need to be specifically addressed in an adequately hydrated patient. Total body stores of potassium and phosphate are often low, despite normal serum concentra- TREATMENT Of course the mainstay of therapy for every diabetic dog and most diabetic cats is insulin. But which type of insulin should you use, what’s the best way to initiate therapy, and how do you ensure that you continue to administer an appropriate dose? What’s the most appropriate diet for a diabetic dog or cat? These considerations are essential in achieving and maintaining good glycemic control. Urinalysis It is essential to determine whether a new diabetic is ketotic. A routine urine dipstick test will readily identify acetone and acetoacetate; the urine must be mixed with hydrogen peroxide to facilitate detection of beta-hydroxybutyrate, which is often the most prevalent ketone body. In early ketosis, renal and respiratory compensation prevent substantial acidosis, but these systems soon become overwhelmed, and dehydration and compromised tissue per- Choosing an insulin Insulins are categorized by species of origin (porcine, bovine, recombinant human) and duration of action (short, intermediate, long) (Table 1). When selecting a product for at-home use, it is important to consider species (feline insulin is most similar to bovine, whereas canine insulin is identical to porcine and similar to human). Feeding habits 602 September 2007 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - September 2007

Contents Letters Leading Off The Veterinary Medicine Interview: Dr. William J. Kay Idea Exchange Practical Matters Salivary Mucoceles in Cates: A Retropspective Study of Seven Cases Hyperlipidemia in Dogs and Cats Purina Insert The Latest Management Recommendations for Cats and Dogs with Nonketotic Diabetes Mellitus CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - September 2007

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