Diabetic Cat

Re: Diabetic Cat

Martin Atkinson — Wed, 14 Aug 2013 17:25:44 GMT

PS Anon - why post anonymously, no-one will think worse of you for having a problem with this case, rather the reverse I'd say, you've handled it rather well so far with limited experience and lack of client compliance. If you're worried your employer may think badly about it, if I was your employer I'd think exactly what I'd just said and be pleased you'd taken the trouble to find out more. Keep it up, no-one posts more things to be embarrassed about than me, I don't care if I'm right or wrong, the important thing is to communicate and learn.

Re: Diabetic Cat

Anthony Dennison — Wed, 14 Aug 2013 14:26:19 GMT

[quote user="Michael Woodhouse"]

Fructosamine ok. Point blood glucose ok.

You sure patient is diabetic?

[/quote]

We've had one that resolved. Is something to think about! A curve will reveal a lot.

Re: Diabetic Cat

Martin Atkinson — Wed, 14 Aug 2013 10:11:52 GMT

Regular glucose curves are the only way forward here otherwise you're pissing into the wind. Fructosamine is of very limited if any use for monitoring a cat on treatment it is only useful for confirming the original diagnosis. This cat is almost certainly over-swinging and the first thing to do is reduce the dose of insulin by 25% and start again. Agree acromegaly is unlikely as there appears to be no insulin resistance. Don't forget you can get CNS signs with uncontrolled diabetics, it is not always hypoglycaemia but at the levels you're reporting it almost certainly is. If the owner doesn't want to play ball for whatever reason there is little you can do, I try to concentrate their minds by telling them that if they don't do what they're told the cat will be dead within 2 years if they co-operate it can have a normal life expectancy. The first thing to learn as a new grad is not to beat yourself up if the client isn't on your side its not your fault. The second is to learn that DM cats are one of the most challenging but ultimately rewarding cases once you have the experience. Finally assuming you've decided this cat hasn't gone into remission with its DM is to consider Lantus glargine which will give a much more stable curve.

Re: Diabetic Cat

S_Dgd — Wed, 14 Aug 2013 10:01:18 GMT

I often find fructosamine pointless in assessing the ongoing management of diabetic patients. The only times I really use it is for confirming diabetes in the first place. If the cat is having hypos and the blood glucose is swinging from high to low this may account for the good fructosamine result which is an average.

I rely on clinical examinations keep an eye on weight and PU/PD, urine samples to keep a check on UTI's, glucose curves and ideally try to get owners on board with checking blood glucose at home when having "strange episodes" or even a mini glucose curve at home is great. Depending on how committed the owners are.

Is this cat overweight-7.4kg seems pretty hefty? I would try to encourage owners to consider gradual diet change to low calorie diet-often if I have resistant owners I suggest by managing the diabetes well and gradual weight loss may increase the chances of remission-that sometimes gives them a nudge in the right direction.

Re: Diabetic Cat

Michael Woodhouse — Wed, 14 Aug 2013 01:03:56 GMT

Fructosamine ok. Point blood glucose ok.

You sure patient is diabetic?

Re: Diabetic Cat

Andrew Kent — Tue, 13 Aug 2013 21:55:33 GMT

It's unlikely to be acromegalic if you are seeing a good ( or too good) response to insulin.

Re: Diabetic Cat

Linda Filshie — Tue, 13 Aug 2013 21:42:04 GMT

Niessen - very close, James!

Re: Diabetic Cat

James Laidlaw — Tue, 13 Aug 2013 21:32:21 GMT

I think Stijn Nilssen (sp?) at the RVC was doing investigations into suspect acromegaly cases and diabetes and they were doing significant testing for very little or possibly no cost. May be worth a call to see if that's still going?

Re: Diabetic Cat

Miriam Lodewyks — Tue, 13 Aug 2013 21:19:42 GMT

Very hard when funds are restricted, and on top of that, client does not sound motivated to do the best they can either! Or else the cat would probably not be weighing as much now. I second the "acromegaly" possibility, though it's tricky to prove (impossible without some funds). Given the mildly raised kidney enzymes, a BP measurement might be helpful (& cheap). Any retinal haemorrhage or occular lesions?

Re: Diabetic Cat

Linda Filshie — Tue, 13 Aug 2013 21:04:57 GMT

Lol! I was just being a bit slow on the uptake . Let us know how you get on.

Re: Diabetic Cat

crazedndazed — Tue, 13 Aug 2013 21:02:12 GMT

Woops, sorry Linda! Glucose curve was what I was thinking as next step. Yes I think fructosamine has been unhelpful. Thank you.

Re: Diabetic Cat

Linda Filshie — Tue, 13 Aug 2013 20:38:43 GMT

Weight gain in an unstable diabetic could be acromegaly (is he showing any other physical signs of this e.g big jaw, change of vocal pitch?). 6.3mmol would be rather low for an afternoon BG if you're dosing BID- I'd defintely want a glucose curve. Fructosamine is unreliable in my opinion. Took me a while to figure out that stan pro was standard profile - I was wondering if this was some brand spanking new test that only new grads know about!

Re: Diabetic Cat

Andrew Kent — Tue, 13 Aug 2013 20:38:40 GMT

Fructosamine is all well and good when clinical signs are well controlled but really doesn't help you in a case like this. You need a glucose curve to get a better idea of what's going on.

Re: Diabetic Cat

Rob Loxley — Tue, 13 Aug 2013 20:25:48 GMT

[quote user="An On MRCVS"]couldnt smell ketones[/quote]

I'm not so confident of my nose so I'd stick to the ketone stick.

[quote user="An On MRCVS"]This owner is very concerned about finances so on limited budget. Where do I go from here?[/quote]

Get them to do a blood glucose on an ear prick when the episode happens, we have some spare glucometers we have lent out in the past.

[quote user="An On MRCVS"]If having hypos then why is fructosamine ok?[/quote]

Maybe because the frucosamine is reflecting the generally well controlled glucose for the rest of the month, and the hypo isn't lasting long enough to 'register'?