VETcpd - Feline Diabetes
Peer Reviewed
Practical management
of feline diabetes –
current best practice
Diabetes mellitus is a common endocrine disorder of cats, comparable to human
type-2 diabetes. Management of affected cats can be challenging but also rewarding,
not least because early appropriate treatment can result in reversal of the diabetic
state (diabetic remission). The International Society of Feline Medicine recently
published Consensus Guidelines on the practical management of this condition and
this article discusses the guidelines and presents important, applicable information.
Areas covered include dietary management, the appropriate use of insulin and how
to monitor and adjust the insulin dosage when managing feline diabetics. This article
also provides a practical guide on teaching owners to measure blood glucose at
home, an invaluable technique for stabilising and monitoring diabetic cats.
Martha Cannon BA VetMB
DSAM(fel), RCVS Recognised
Specialist in Feline Medicine
Martha is a trustee-director of
International Cat Care and a committed
supporter of the International Society
of Feline Medicine’s Cat Friendly
Clinic scheme, encouraging veterinary
practices to make veterinary visits less
stressful for cats and their owners.The
Oxford Cat Clinic
78A Westway, Botley,
Oxford, OX2 9JU
Tel: 01865 243000
Email: [email protected]
www.oxfordcatclinic.co.uk
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Key words: feline diabetes mellitus, consensus guidelines, home blood glucose
testing, Somogyi, blood glucose curve
Introduction
iStockPhoto.com
Martha graduated from Cambridge
University as a veterinary surgeon
in 1992 and spent time in practice,
including setting up a radioactive iodine
treatment centre, before completing a
Feline Advisory Bureau residency at
Bristol University. She is currently an
RCVS Specialist in Feline Medicine and
co-director at the Oxford Cat Clinic, a
first opinion and medical referral catonly clinic in Oxford.
Diabetes mellitus is
a common disease
in cats, dogs and
humans. In dogs,
most affected animals
have a disease similar
to human type-1
diabetes, caused
by reduced insulin
production from pancreatic β-cells. By
contrast in cats, the majority of cases
appear to result from a combination of
both reduced insulin production and
reduced insulin responsiveness (insulin
resistance), more akin to the situation in
human type-2 and type-3 diabetes. This
is of more than just academic interest
because it has significant bearing on
the aims of treatment and the approach
to treatment of the diabetic cat when
compared to the diabetic dog. In particular
the difference in pathophysiology means
that for a proportion of cats, diabetes
may be a temporary condition which can
be largely reversed by appropriate early
treatment, leading to a state of “diabetic
remission”. This can be a very positive
outcome for affected cats and their
owners, and can be a valuable motivating
force in encouraging owners to adopt
effective early treatment. However it
can also lead to complications in the
management of diabetes mellitus because
a cat’s insulin requirement can reduce
over time, and if diabetic remission is not
recognised, over-dose of insulin can result.
The International Society of Feline
Medicine has recently published a set of
Consensus Guidelines on the Practical
Management of Diabetes Mellitus in
Cats (Sparkes et al. 2015). The Guidelines
have been developed by an independent
panel of clinicians and academics with
the aim of producing practical advice for
dealing with the diabetic cat, based on
currently available best evidence. This
article highlights the key points from these
Guidelines, which are available free to
access and download at www.jfm.sagepub.
com/content/17/3/235.full.pdf+html
Aims of treatment
While we now recognise that diabetic
remission is a potential outcome for
many diabetic cats, the primary aims of
treatment remain more straightforward:
• To limit or eliminate the cat’s clinical
signs
• To use a treatment regime that is
affordable and fits into the owner’s
daily routines
• To avoid insulin-induced hypoglycaemia
and to prevent other life-threatening
complications e.g. diabetic ketoacidosis
In many cases it is possible to achieve and
maintain very good glycaemic control
and it appears that diabetic remission is
more likely in cats with better glycaemic
control. However on occasion it can be
difficult to fully control hyperglycaemia
without risking periods of hypoglycaemia,
VETcpd - Vol 2 - Issue 3 - Page 31
VETcpd - Feline Diabetes
Box 1: Home monitoring of blood glucose
Home monitoring of blood glucose levels
can be invaluable for stabilising and
monitoring diabetic cats. It allows owners
to identify cats at risk of hypoglycaemia
and may improve the level of glycaemic
control that can be achieved.
A drop of blood is obtained from the
marginal ear vein (see Figure A) or from
the metacarpal or metatarsal pads. A
hand-held glucometer is used to obtain
the blood glucose reading (see Figure B).
Most cats tolerate the procedure very
well and with adequate teaching and
support the majority of owners are able
to perform home monitoring of blood
glucose. The concept should therefore
be introduced early in the management
of diabetes, with assistance provided to
owners by means of demonstrations of
the technique at visits to the practice,
use of printed and web-based support
materials and telephone support from
vets and veterinary nurses. A useful
owner instruction video is available via:
• International Cat Care - http://www.
icatcare.org:8080/advice/video
Figure A
Figure B
Figure C
Figure D
• Oxford Cat Clinic - http://www.
oxfordcatclinic.co.uk/CatsFAQs1539.html
Equipment:
• Simple to use monitor that accepts
strips filled by capillary action, and
that is unaffected by the angle at which
it is held. The only feline-validated
glucometer currently available is the
AlphaTRAK 2 meter (Abbott, see Figure
B) and this should ideally be used,
despite the increased initial outlay
cost to the owner. Glucose meters
designed for human blood tend to
under-estimate the blood glucose level
in cat’s blood, although this is rarely of
clinical significance
• Cotton wool ball
• 23 gauge hypodermic needle
• Good lighting – to view the marginal
ear vein
• Vaseline – to prevent blood drop
dissipating
• Treats – for use during the training
period
Method:
• Successful monitoring requires an
owner who is prepared to spend some
time with the cat accustoming it to the
technique
• Choose a site where the cat will rest
Page 32 - VETcpd - Vol 2 - Issue 3
Figure E
comfortably. Familiarise the cat to
being stroked and given treats at this
site at regular times. Familiarise the cat
with handling of the ears
• Set up the glucometer and insert a
test strip
• Visualise the peripheral ear vein, which
runs parallel to and approximately
1-2 mm inside the edge of the pinna.
The vein can be clearly seen in most
short-haired cats, especially when
highlighted by a bright light (see Figure
A). In long-haired cats and dark coated
short-haired cats it may help to shave
the ear when owners first start to do
home monitoring
• Place the cotton wool on the inside of
the pinna and prick the outer surface
Figure A: The AlphaTRAK 2 meter (Abbott)
is the only currently available feline-validated
glucometer
Figure B: The peripheral ear vein runs parallel to
and approximately 1-2 mm inside the edge of
the pinna
Figure C: Place the cotton wall on the inside of
the pinna and prick the outer surface of the ear
over the peripheral vein
Figure D: Allow a small drop of blood to form
Figure E: Introduce the tip of the glucometer
strip to the blood
of the ear over the peripheral vein (see
Figure C), allow a small drop of blood
to form (Figure D). A small amount
of Vaseline can be placed at the site
before pricking to prevent the bleb
of blood from dissipating. If a drop
of blood doesn’t form straight away,
gently massage the ear each side of
the prick-site to encourage bleeding
• Introduce the tip of the glucometer
strip to the blood (See Figure E)
• Move the cotton wool over the earprick and apply gentle pressure until
the bleeding stops
Serial samples can be collected from
different sites, working around the ear
margin and from one ear to the other.
Full article available for purchase at www.vetcpd.co.uk/modules/