Diagnosis & Management

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Diagnosing Feline Diabetes

Diagnosing feline diabetes can be challenging due to their propensity to develop stress-induced hyperglycemia. Cats presenting persistent classic clinical signs of diabetes, such as polydipsia (PD), polyuria (PU), and weight loss despite good appetite should be further monitored for corroborative laboratory test results showing hyperglycemia and glycosuria.

Also, conduct blood serum and urinalysis testing to rule out infections and other underlying medical conditions. Plantigrade stance presents as a characteristic clinical sign of advanced feline diabetes.

Confirm a preliminary diagnosis of diabetes mellitus based on clinical signs with blood and urine tests. Glycosuria combined with hyperglycemia (>300 mg/dL) indicates diabetes mellitus. Although it is common for cats without diabetes to develop transient hyperglycemia in times of stress, such as during blood sample collection, the urine glucose should be negative in a cat without diabetes.

Because stress-induced hyperglycemia can result in blood glucose concentrations of 300 mg/dL to 400 mg/dL, it can confound the interpretation of blood glucose results. Persistent hyperglycemia and glycosuria should therefore be present to definitively establish diabetes diagnosis. It’s useful to measure serum fructosamine concentrations because they remain normal in stress-induced hyperglycemia and elevated in sustained hyperglycemia.

Evaluating glucose accumulation in urine is a useful diagnostic tool in making a definitive diagnosis of diabetes in cats. Since it takes several hours of stress for detectable glucose to accumulate in the urine, glycosuria will not be present in cats with stress-induced hyperglycemia. In addition to the absence of glycosuria, none of the typical clinical signs of diabetes are present in cats with stress-induced hyperglycemia.

Diabetes Management

When a diagnosis of diabetes has been confirmed, begin management with Vetsulin^® (porcine insulin zinc suspension). A diet appropriate for cats with diabetes should be started as well.

The goals in managing diabetes mellitus are to minimize the clinical signs of diabetes, the risk of hypoglycemia, and the development of long-term complications. Accomplishing these 3 goals requires that pet owners understand all aspects of diabetes management. It pays to invest sufficient time to carefully explain all aspects of diabetes therapy to your clients.

Managing diabetes can be an exercise in frustration until stabilization occurs; however, this website offers help to veterinary professionals as they evaluate the disease and its management. It also provides tools and resources (see additional support).

Management of diabetes mellitus in cats includes insulin and diet. For intact females, spaying is required because of the hormonal changes during the estrous cycle. In particular, the elevated progesterone level is antagonistic to the action of insulin. Oral hypoglycemic agents have a limited use in cats with Type 2 diabetes.

Insulin forms one of the cornerstones of the management of diabetes mellitus; therefore, it’s important to understand the length of action of insulin and how to evaluate therapy.

Evaluation of Management

Monitoring blood glucose is a good way to evaluate regulation of cats with diabetes. It’s accurate, quick, and requires only a drop of blood. However, in certain conditions (see below), it’s not reliable because blood glucose concentration is influenced by many factors and may not show an accurate result of insulin management.

Various factors such as economics, logistics, and clinical situations can also force veterinarians to limit diagnostic procedures. When it’s not possible to perform a complete glucose curve, punctual blood samples combined with assessment of clinical signs, general observations, and evaluating glycosuria can provide an overview of the animal with diabetes. Veterinarians can also rely on evaluation of glycosylated hemoglobin (HbA1c) and serum fructosamine in laboratory testing.

Non-Insulin Factors Affecting Management

Food intake, cat and owner cooperation, use of a drug (eg, prednisolone, progestogens, megestrol acetate), concurrent disease conditions (eg, hyperadrenocorticism, acromegaly), or stress can affect blood glucose levels. In these cases, blood glucose measurement will need to be interpreted in combination with other methods of evaluation.

Help Your Practice Manage Diabetes Mellitus

Check out these tools and resources to help manage feline diabetes.

Read More About Feline Diagnosis & Management

Important Safety Information:

Vetsulin^® should not be used in dogs known to have a systemic allergy to pork or pork products. Vetsulin is contraindicated during periods of hypoglycemia. Keep out of reach of children. As with all insulin products, careful patient monitoring for hypoglycemia and hyperglycemia is essential to attain and maintain adequate glycemic control and prevent associated complications. Overdosage can result in profound hypoglycemia and death. The safety and effectiveness of Vetsulin in puppies, breeding, pregnant, and lactating dogs has not been evaluated. See package insert for full information regarding contraindications, warnings, and precautions.

References:

1. Martin GJ, Rand JS. Pharmacology of a 40 IU/ml porcine lente insulin preparation in diabetic cats: findings during the first week and after 5 or 9 weeks of therapy. J Feline Med Surg. 2001;3(1):23–30. 2. Vetsulin^® (porcine insulin zinc suspension) [Freedom of Information Summary]. Millsboro, DE: Intervet Inc.; 2008. 3. Data on file, Merck Animal Health. 4. Graham PA, Nash AS, McKellar QA. Pharmacokinetics of porcine insulin zinc suspension in diabetic dogs. J Small Anim Pract. 1997;38(10):434–438. 5. Martin GJ, Rand JS. Pharmacokinetic and Pharmacodynamic Study of Caninsulin in Cats with Diabetes Mellitus. 2000: Internal Study Report. 6. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:539–579. 7. Tennant B, ed. BSAVA Small Animal Formulary. 4th ed. Gloucestershire, UK: British Small Animal Veterinary Association; 2002. 8. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. 3rd ed. St. Louis, MO: Saunders; 2004:486–538. 9. Reusch C. Feline diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1796–1816. 10. Nelson RW. Canine diabetes mellitus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. St. Louis, MO: Saunders; 2010:1782–1796. 11. Burgaud S, Riant S, Piau N. Comparative laboratory evaluation of dose delivery using a veterinary insulin pen. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 121. 12. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic dogs. In: Proceedings of the WSAVA/ FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 122. 13. Burgaud S, Guillot R, Harnois-Milon G. Clinical evaluation of a veterinary insulin pen in diabetic cats. In: Proceedings of the WSAVA/FECAVA/BSAVA congress; 12–15 April 2012; Birmingham, UK. Abstract 45. 14. Davison LJ, Walding B, Herrtage ME, Catchpole B. Anti-insulin antibodies in diabetic dogs before and after treatment with different insulin preparations. J Vet Intern Med. 2008;22:1317-1325. 15. Banfield State of Pet Health 2016 Report. p 12-13.