Caparrós Vallcorba, Cristina

Universitat Autònoma de Barcelona. Facultat de Veterinària

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Management of feline diabetes mellitus: update and challengesCristina Caparrós VallcorbaJune 2017This study intends to perform an updated revision of the managementof feline diabetes mellitus (DM):• Focusing in the importance of the nutritional management tocontrol blood glucose (BG) values• Evaluating the different insulin types currently available on themarket and comparing its short and long term efficacy• Emphasizing the importance of the intensive patient monitoringand the difficulties in the real clinical practiceDM is one of the most frequent endocrinal diseases in cats(prevalence of 0.2-1%). It is defined as a persistent hyperglycaemiacaused by a relative or absolute insulin deficiency. The 80% of thecats suffer type 2 DM, characterized by the presence of insulinresistance and β pancreatic cell dysfunction. Despite the fact that is aneasily diagnosed disease, its management display importantchallenges and require the active participation of the owner toaccomplish an intensive BG control, especially if the remission of thedisease is sought.The odds of remission are between 33-100% with the combination ofinsulin therapy and nutritional management. The objective will be toreduce the high post-prandial glycemia of cats. The different optionsfor the diet are:Another important consideration is to feed the animal with a wet-fooddiet instead of a dry-food diet:• Lower CH content• Lower energy density• Highest water contentTable 1. Relevant data of different insulin types 1The different duration between insulin types lead to diverse mean 12hBG concentrations (Figure 1). Lente insulin shorter action induceperiods of hyperglycemia during the day and the progression of disease.Figure 1. Mean BG concentration curve of different insulin types 2Glargina and Detemir have a consistent profile activity instead of acutepeak activity of Lente insulin and PZI, providing lower probability ofclinical hypoglycaemia and a tight BG control.An intensive treatment with Glargina or Detemir including correctnutritional management achieves greater remission rates than Lenteinsulin or PZI.AIMSINTRODUCTIONNUTRITIONAL MANAGEMENT• Although is preferable to fed with a low-CH/high-protein diet, patients should be assessed individually in nutritional management as there is noproper diet for all of them, especially in cases of obesity and chronic kidney disease.• Most recent experimental studies reveal that long-acting insulins, glargina and detemir particularly, are the best option for the treatment during firstmonths after diagnosis. Administrating the doses every 12 h achieves smaller daily BG fluctuations and greater remission rates.• Further experimental studies on detemir action are needed. Although different sources affirm that detemir and glargine have very similartherapeutic results, there are certain findings indicating that detemir could have longer duration than glargine.• It is necessary to improve home monitoring tools and involve the owner for tight control of the disease, which increases remission possibilities.Low-carbohydrate (CH) / High-protein diet Stabilize glucose metabolism Reduce or remove the needs of exogenousinsulin Avoiding loss of muscle mass To prevent the development of hepatic lipidosis≤12% CH(of total calories)>40% protein(of total calories)High-fiber diet Delay or decrease carbohydrate absorption Contains half caloric density comparing withlow CH diets (with greater fat content)13% fiber(of dry matter)Low-protein / Low phosphorus diet Extend survival time and improve patient life quality22% protein(of total calories)1st optionObesityChronic Kidney DiseaseAchieve greater feeling of satietythat favours los of weightINSULIN TREATMENTInsulin typesPeak activity(post-injection)Duration of effectFrequency of administrationMedium-acting2-8 h 8-10 h q8-12 h Lente insulinLong-acting2-6 h 13-24 h q12hProtamine zinc insulin (PZI)Glargine12-14 h12 a >24h (10-16h)q12hDetemirFigure 2. Cumulative proportion of cats going into remission 2Intensive monitoring is necessary to apply the correct changes ininsulin dose, which should be based in clinical signs, BG values and theinsulin action duration.In large term, the information provided by the owner will be essential toindicate the disease development. The most important parameters aredaily water intake (20 ml/kg/day in a good control), urine production,body weight, urine glucose and BG as often as possible.MONITORINGInsulin types Initial dose BG values Maximum dose change frequencyMedium-acting 0.25-0.5 UI/kg q12hNadir Every 3-5 daysLong-acting Pre-insulin Every 5-7 days[1]: Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A, Hoenig M, Peterson ME, Reusch CE, Taylor S, Rosenberg D. 2015. ISFM Consensus Guidelines on the Practical Management of Diabetes Mellitus in Cats. J Feline Med Surg 17:235-250.[2]: Marshall RD, Rand JS, Morton JM. 2008. Glargine and protamine zinc insulin have a longer duration of action and result in lower mean daily glucose concentrations than lente insulin in healthy cats. J. Vet. Pharmacol. Ther. 31:205–212.CONCLUSIONS

Management of feline diabetes mellitus: update and challenges

https://ddd.uab.cat/pub/tfg/2017/180276/TFG_ccaparrosvallcorba_poster.pdf

Management of feline diabetes mellitus: update and challenges

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