Page 363 - Problem-Based Feline Medicine

18 – THE THIN, INAPPETENT CAT 355

the teeth caudal to the canines. Occasionally Body condition varies from obese to thin.
removal of the canines and incisors is also required.
Coat condition is often poor, with seborrhea and scales.
Systemic antibiotics frequently produce only a tran-
Hepatomegaly is common. If diabetes mellitus is asso-
sient improvement.
ciated with pancreatitis, abdominal discomfort may be
● Effective antibiotics include clindamycin, clavu-
present.
lanate potentiated amoxycillin, metro-nidazole and
spiramycin (which is concentrated in saliva). A plantigrade stance may be noted due to diabetic
neuropathy.
Immunosuppressive therapy appears to produce the
most reliable responses in chronic cases. If the diabetic cat is ketoacidotic, dehydration, depres-
● Prednisolone (2–4 mg/kg PO once daily) on a taper- sion and weakness may also be present.
ing regime to the lowest maintenance dose.
● In cases failing to respond to corticosteroid therapy,
Diagnosis
alternative immunosuppressive or immunomodulat-
ing therapies should be considered. Documenting a persistent fasting hyperglycemia
– Including chlorambucil, cyclosporin A, gold (blood glucose > 12 mmol/L, 217 mg/dl) and gluco-
salts, human recombinant interferon alpha and suria in a cat with appropriate clinical signs is
topical application of bovine lactoferrin. There required to establish a diagnosis of diabetes mellitus.
have been few studies evaluating these drugs and ● It is important to distinguish diabetes mellitus from
most have more potential side effects, requiring stress hyperglycemia.
closer monitoring. – Glucosuria rarely results from stress hyper-
glycemia because the hyperglycemia is usually
below the renal threshold or only transient, how-
DIABETES MELLITUS ever glucosuria does not exclude this possibility.
– Monitoring for glucosuria at home may aid dif-
Classical signs ferentiation.

● More common in older cats, especially Blood glycosylated hemoglobin and serum fruc-
neutered males. tosamine concentrations represent the average
● Polyuria and polydipsia. blood glucose concentrations over the preceding 4–6
● Usually polyphagia and weight loss. weeks and 2–3 weeks respectively.
● May progress to decreased appetite. ● They may be helpful to distinguish diabetes melli-
tus from stress hyperglycemia.
See main references on page 236 for details (The Cat ● They also provide further information regarding
With Polydipsia and Polyuria). glycemic control when monitoring patients under
treatment.
Clinical signs Further investigation is required to assess for concurrent
disease or systemic complications of diabetes mellitus.
Although diabetes mellitus may occur in any cat, it is
● Routine hematology and biochemistry, including
more frequent in older cats, especially neutered males.
assessment of electrolytes.
● In some regions Burmese cats may be predisposed.
– Diabetic cats frequently have mild to moderate
The classic clinical signs are those of polydipsia, increases in hepatic enzymes and cholesterol.
polyuria, polyphagia and weight loss. – Concurrent renal failure or pre-renal azotemia
● These signs are frequently unnoticed by cat owners. may be present.
● Therefore many cats do not present until the cat ● Complete urinalysis should be carried out.
develops more severe clinical signs such as inappe- – The presence of ketones in the urine confirms
tence, vomiting and depression. the diagnosis of diabetes mellitus. Sick ketoaci-
– These clinical signs may be associated with the dotic cats require aggressive monitoring and
development of ketoacidosis. management.