Page 2715 - Cote clinical veterinary advisor dogs and cats 4th

1410 Diabetes Mellitus: Treatment

Diabetes Mellitus: Treatment
VetBooks.ir Treatment of nonketotic

diabetes mellitus

Cats Dogs
Clinician Preference

Relatively healthy; owner Administer glargine insulin Administer PZI insulin • Administer NPH or Lente insulin
refuses insulin treatment (1-2 U/CAT SQ q 12h); (1 U/CAT SQ q 12h); (0.25 U/kg SQ q 12h)
restrict carbohydrate restrict carbohydrate • Consider diet with increased
content of diet content of diet fiber if normal body weight or
overweight
• Spay if intact female
• Administer glipizide • Check 2 or 3 blood glucose values • Keep exercise consistent
2.5 mg/CAT orally q 12h; throughout the day to ensure no
restrict carbohydrate hypoglycemia
content of diet • Send home and reassess clinical
• Reassess in 2 weeks signs and 12-hour blood glucose curve
(i.e., blood glucose measured q 2h)
q 7 days until diabetes controlled • Check 2 to 3 blood glucose con-
centrations throughout the day to
Are clinical signs controlled? ensure no hypoglycemia
• Send home and reassess clinical
Yes No No signs and 12-hour blood glucose
curve (i.e., blood glucose measured
q 2h) q 7 days until diabetes
Continue If clinical signs If cat is still relatively controlled
treatment are worse or healthy and no
adverse effects adverse effects of
of treatment are treatment are seen,
seen, reconsider increase dose to Is diabetes controlled (i.e., clinical
insulin treatment 5 mg and reassess signs resolved and blood glucose
in 2 weeks concentrations 100-300 mg/dL
[5.5-16.7 mmol/L])?

No No No No Yes

Are all or most Are all or most blood glucose Are one or more Are some blood • Continue treatment and reassess clinical
blood glucose values above the desired range blood glucose glucose values in signs, physical examination, and serum
values above and no hypoglycemia, but with a values below the the desired range fructosamine q 3-6 months or sooner if
the desired dose of at least 1.5 U/kg? If yes: desired range but but too high at signs recur
range but • Rule out owner administration others are the start and end • Consider diabetic remission (cats) if clinical
there is no error or inactive insulin above the desired of the curve? signs have resolved and persistent blood
hypoglycemia, • Investigate causes of insulin range? If yes, If yes, decrease glucose <100 mg/dL (<5.5 mmol/L)
and the dose antagonism or resistance (e.g., decrease dose dose interval or
is less than hyperadrenocorticism, diestrus, and reassess in change to a
1.5 U/kg? diabetogenic drugs, infection, 7 to 10 days longer-acting
If yes: chronic pancreatitis, hyperthy- insulin and
• Increase dose roidism [cat], acromegaly [cat], reassess in Is there a recurrence Are there no clinical
and reassess in renal insuffiency, severe 7 to 10 days of clinical signs, signs, normal
7-10 days obesity, congestive heart failure) abnormal physical physical examina-
• Treat any identified disorders examination, and/or tion, and good
and then reassess diabetic fructosamine serum fructosamine
control concentration? If yes, concentration?
evaluate 12-hour
glucose curve

NPH, Neutral protamine Hagedorn; PZI, protamine zinc insulin; SQ, subcutaneous.
UPDATED AND EDITED BY: Leah A. Cohn, DVM, PhD, DACVIM
ORIGINALLY WRITTEN BY: Sherri Ihle

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