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Diabetes Mellitus 253

• Owner understanding of disease and good • Support from the veterinary and nursing ○ Glycated proteins (fructosamine, glycosyl-
team is essential, especially in the beginning.
communication between owners and the • Various monitoring methods exist, all with ○ Urine glucose: useful to screen for remis-
ated hemoglobin)
VetBooks.ir • Remission can be achieved in a proportion of advantages and disadvantages; an individual- sion (if urine does not contain glucose); Diseases and Disorders
health care team are essential.
not to be used to increase insulin dose
diabetic cats (approximately 30% in a general
ized monitoring regimen should be discussed
population, 80% of acromegaly-induced
with the owner.
diabetics). • The clinical picture should always lead a ○ Continuous subcutaneous glucose
monitoring systems (e.g., Freestyle Libre,
• No unbiased evidence exists proving that treatment decision. Guardian, Dexcom)
protocols that aim for euglycemia are superior • Using a clinical scoring system for the clinical ○ All above parameters can be influenced
to traditional control protocols in cats. signs standardizes communication between by nondiabetic factors such as stress and
owner and medical team. day-to-day variation; they should always
Acute General Treatment be interpreted with caution and in light
• Address the underlying or associated disease Nutrition/Diet of the clinical picture.
and/or risk factors as soon as possible. • Cats ideally should be transitioned to a
• DM should be treated as soon as possible low-carbohydrate (<7% of metabolizable PROGNOSIS & OUTCOME
with exogenous insulin injections and an energy), wet diet.
appropriate dietary regimen in stable patients • For dogs, diet should be changed only if • DM can be treated effectively in most cases,
with preserved appetite. obesity or comorbidity needs to be addressed. provided clinician, nurse/technician, and
• An insulin preparation should be chosen that • Dogs and cats should be given a palatable owner work as a team.
is legal to be used in the relevant country diet that is eaten reliably in an amount aimed • Remission is possible in cats, especially if an
and is long acting. at an ideal body condition. underlying condition is present that can be
○ Protamine zinc insulin (ProZinc), glargine • Should ideally be fed two meals of one- controlled/cured. Remission is rare in dogs
(Lantus), and detemir (Levemir) have half their daily caloric requirement (unless except for pregnancy/progesterone-related
proved to be equally successful for use overweight/obese) roughly 12 hours apart. DM.
in cats. Graze feeding can be continued if preferred
○ Porcine lente insulin (Caninsulin, Vetsulin) by patient. PEARLS & CONSIDERATIONS
and detemir (Levemir) have proved useful
in dogs. Behavior/Exercise Comments
○ NPH insulin often proves to be short- Exercise levels are best kept constant, result- The veterinary team should acknowledge the
acting for dogs and especially for cats. ing in reliable and predictable insulin need. impact of the daily treatment regimen on the
• For most insulin types (exception: detemir) Exercise should be increased for overweight/ pet and owner. A validated QoL tool (i.e.,
a safe starting dose is 0.25-0.5 units/kg obese animals. DIAQoL-pet) can be used to investigate and
(dog) or 1 unit/CAT SQ q 12h. monitor impact.
• Insulin response is highly variable among Possible Complications
patients; most insulin types need to be used • Diabetic ketoacidosis (p. 254) or hyperos- Prevention
twice daily in most patients. molar syndrome Prevent diabetogenic risk factors (see ALIVE
• Occasionally, insulin administration before • Insulin use can cause hypoglycemia; to avoid etiologic classification of DM).
feeding (up to 1 hour) can prove beneficial this
by matching insulin peak activity with post- ○ Use a conservative starting dose. Technician Tips
prandial hyperglycemia, especially in dogs. ○ Avoid rapid dose increases. • Regular recording of body weight and body
• Immediate treatment goals should be that ○ Avoid BG values close to the hypoglycemic condition score (9-point scale) is essential.
owner and pet become familiar with insulin range. • To measure QoL of diabetic pets and their
injections and that owners can monitor ○ Periodically screen for possible hypo- owners, use the DIAQoL-pet by the Royal
clinical signs. glycemia when there are no diabetic Veterinary College Pet Diabetes App. It also
• In general, oral hypoglycemic drugs (sulfonyl- signs (e.g., absence of morning glucosuria serves as a tool to communicate clinical data.
ureas such as glipizide) should be considered indicates possible hypoglycemia). (Android: http://bit.ly/1q3jCV5 and iPhone:
only in cats, and they uncommonly prove ○ Ensure good owner education/ http://apple.co/203OoK2).
successful; acarbose can be used in combina- communication.
tion with insulin in dogs or cats but is seldom Client Education
helpful. Recommended Monitoring Evidence-based information and pet dia-
• If DKA or hyperosmolar syndrome is present, • Various methods are available. betes videos can be found on Facebook
hospitalize and treat accordingly (p. 254) • Clinical picture is the most important (www.facebook.com/RVC.Diabetic.Remission
monitoring tool (consider using scoring .Clinic).
Chronic Treatment system).
• After insulin is started, the animal is sent • Various apps are available to enable com- SUGGESTED READING
home. munication and structured recording of Gilor C, et al: What’s in a name? Classification of
• Unless hypoglycemia occurs, insulin dose relevant information. diabetes mellitus in veterinary medicine and why
changes should not occur quickly, leaving • Choice of glycemic monitoring tool depends it matters. J Vet Intern Med 30(4):927-940, 2016.
7-10 days between each dose change. on owner and pet factors. AUTHOR: Stijn J.M. Niessen, DVM, PhD, DECVIM,
• If hypoglycemia is present at any time, insulin • Glycemic indicators can be used on their FHEA
dose must be decreased. own or in combination: EDITOR: Ellen N. Behrend, VMD, PhD, DACVIM
• Consider introducing the owner to home ○ Serial blood glucose curve (usually q 2h
blood glucose monitoring (HBGM). for 12 hours)

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