Veterinary Medicine - September 2007 - (Page 606)

Diabetes management O P E E R - R E V I E W E D FIGURE 1 Protocol for initiating glargine therapy in nonketotic diabetic cats The cat is stable and nonketotic, and diabetes has been confirmed with fructosamine measurement. If the cat’s blood glucose concentration is > 360 mg/dl, use glargine at a dose of 0.5 U/kg subcutaneously. If the cat’s blood glucose concentration is 200 to 360 mg/dl, use glargine at a dose of 0.25 U/kg subcutaneously. Check the glucose concentration every four hours for 24 hours. If the glucose concentration drops below 70 mg/dl, decrease the insulin dose by 1 U. If the glucose nadir is between 70 and 180 mg/dl, continue the present insulin dose and send the cat home. If the glucose concentration stays above 180 mg/dl, continue the present insulin dose and send the cat home. Have the owner administer the insulin every 12 hours and monitor the glucose concentration at home before each dose for the next three days. If the glucose concentration before insulin administration is 180 mg/dl, continue the present insulin dose. Repeat the glucose curve in seven days. sulin that is available in a U-100 concentration (Lantus—Sanofi Aventis). It is a novel engineered insulin with an ultra-long duration of activity. It can take a few days to achieve its maximal effect, and overdose can result in up to 72 hours of hypoglycemia. It is well-suited to cats, as the prolonged effect matches their tendency to eat small, frequent meals. Many cats quickly achieve glycemic control, generally on a twice-daily dosing schedule. The recommended starting dose is 0.5 U/kg of ideal body weight for cats with glucose concentrations > 360 mg/dl and 0.25 U/kg of ideal body weight for cats with glucose concentrations between 200 and 360 mg/dl (Figure 1).2 A surprisingly large number of newly diagnosed diabetic cats receiving glargine go into remission, most likely because of the reversal of glucose toxicity,9 a condition in which persistent hyperglycemia inhibits the release of insulin from the pancreatic beta cells. If the glucose concentrations are quickly normalized, the beta cells regain function, and the diabetes may resolve. This insulin cannot be diluted, as its effect is pH-dependent. Dosing accuracy is improved if 0.3-ml 100-U syringes are used. It is available in 10-ml vials and 3-ml cartridges; for cost reasons, some clients prefer to purchase the cartridges and have the insulin decanted by a pharmacist into an appropriate container. Starting insulin Ideally, the first dose of insulin should be administered in the hospital so that blood glucose concentrations can be monitored for the first 12 to 24 hours. It is not necessary to achieve optimal control at this point. Instead, the goal is to provide enough insulin to prevent ketosis without risking hypoglycemia. If anything, leaving the patient slightly hyperglycemic is appropriate. Exercise and activity are likely to be higher at home than in the clinic setting, which will tend to drive glucose concentrations down. When a ballpark insulin dose (i.e. enough to prevent ketosis but with minimal risk of hypoglycemia) has been established, the patient can be sent home. See Figures 1 606 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

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.