Long-Term Management

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Stabilizing Feline Diabetes with Maintenance

Help clients understand that with proper care their cats can live healthy, active lives.

Monitoring

Once you’ve established the maintenance dose and the cat is stable, you must implement a long-term management program. The aim is to minimize variations in insulin requirement. This includes monitoring to detect underdosage or overdosage of insulin and dose adjustment, if required. Careful monitoring during maintenance will help limit chronic problems associated with diabetes. Encourage your pet owners to monitor and record their cat’s general health (including well-being, thirst, and appetite) and check urine glucose daily.

After the maintenance dose of Vetsulin^® (porcine insulin zinc suspension) has been established based on the blood glucose curves, you can recheck your feline patient less frequently (every 2 to 4 months; weekly if clinical signs reappear) for general health, urine glucose, and blood glucose levels. If there is a sudden return of polyuria (PU), polydipsia (PD), or polyphagia, the patient should be evaluated, and glycemic control should be assessed using the chosen monitoring method.

Because the albumin to which fructosamine binds degrades in the body every 14 to 21 days, fructosamine reflects the average blood glucose levels over the previous 1 to 3 weeks. Fructosamine levels in a cat’s body are not affected by insulin or stress factors, so they can be taken any time of day and only a single sample is required.

Clinical Signs

If the cat shows signs of dysregulation, such as PU/PD or polyphagia, the owner should be advised to bring the cat in for examination. It’s extremely important that owners are able to recognize the signs of hypo- or hyperglycemia and respond appropriately. PU, PD, or polyphagia accompanied by weight loss, general bad condition, loss of hair, abnormal furry coat, or lethargy are the most common clinical signs of hyperglycemia.

However, these clinical signs may also be present due to a rebound hyperglycemia secondary to a hypoglycemic episode (Somogyi overswing). While a blood glucose curve can help differentiate between insufficient insulin dosing and Somogyi overswing, the results can be confusing if the rebound hyperglycemia persists for a few days. Evaluating weight changes in the patient can help shed some light. If the cat is losing weight and exhibiting clinical signs of diabetes mellitus, the insulin dose may be insufficient. If the cat is gaining weight but continues to have clinical signs consistent with diabetes mellitus, the insulin dose may be excessive, and causing Somogyi overswing.

Keep in mind that blood glucose curves at the hospital only approximate how the cat responds to insulin at home. Feeding and exercise patterns are different, and stress (especially in cats) can alter the glycemic response. So, it’s critical to take into account clinical signs (or lack thereof) when you’re contemplating any change in insulin therapy. The ultimate goal in regulating a cat with diabetes is to control the clinical signs adequately.

Owners should understand that their cats can live healthy, active lives when their cats’ diabetes is properly regulated. They should also know that cats usually require lifelong treatment with an insulin preparation, although some may go into clinical remission.

Help Your Practice Manage Diabetes Mellitus

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

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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.