DM alongside Azotaemia

RE: DM alongside Azotaemia

Martin Atkinson — Wed, 15 Jul 2015 18:16:19 GMT

[quote user="Anthony Dennison"] Very wobbly, like he was drunk, couldn't walk in a straight line, hind limbs were plantigrade and he couldn't really hold himself up.[/quote]Did they measure its electrolytes?

PS Whoops, Kate beat me to it!

RE: DM alongside Azotaemia

Anthony Dennison — Wed, 15 Jul 2015 12:42:37 GMT

Na+: 161mmol/L (150-165)

K+: 3.8mmol/L (3.5-5.8)

Cl-: 122mmol/L (112-129)

BP is something I haven't done yet, same with scanning the kidneys, but it's something I'm planning on doing before the end of the week. All bloods were run in house on a procyte and catalyst dx from Idexx.

A Fructosamine was also run - now at 194 (prev 279).

RE: DM alongside Azotaemia

Kate Richardson — Wed, 15 Jul 2015 12:25:42 GMT

Strange. Did they measure electrolytes or BP- would be interested to know K and Ca.

The UPC is in the borderline zone, but I agree not significantly raised.

Wonder if measuring insulin levels would be of any use? Abdo scan to check kidneys and bladder and pancreas?

But the lab work you have there doesn't offer an immediate explanation for the ataxia.

I would also have a chat with your lab- if they aren't much help, worth a call to Andy Torrance or Oliver Coldrick at TDDS lab.

I'll keep thinking!

I have a cat with similar at the mo as well, BG was around 15 on a pre op blood and urine obtained later had +++glucose- upc also wnl, and no uti, fructosamine also normal. Cat was in for dental, no clinical signs consistent with DM. cat is currently well, so plan to recheck urine first.

RE: DM alongside Azotaemia

Anthony Dennison — Wed, 15 Jul 2015 10:06:11 GMT

Right, update on this case.

Cat has now been off insulin for over a week. On Saturday the owner came home and he was 'having a funny turn'. Very wobbly, like he was drunk, couldn't walk in a straight line, hind limbs were plantigrade and he couldn't really hold himself up. Went to our OOH centre, glucose was 16.11mmol/L, urea and creatinine hadn't changed. UPC was 0.25 (no significant proteinuria). Glucose +++ on dipstick, prot -ve, Bilirubin +, pH 5, slight ketones?

Had s/c fluids (vet couldn't get a cannula in either cephalic) hourly, and was fine the next day. Is back at home on diabetic food, and is asking for food a lot.

What is going on with this cat?!?

RE: DM alongside Azotaemia

Silvia Maldonado — Mon, 13 Jul 2015 21:29:42 GMT

Hi, team,

I've been listening to today's webinar about CKD and using the SDMA (symmetric dimethylarginine) as a biomarker for the very first stages of renal disease. To me, it all was brand new information, and I would like to know if any of you has use it and what was the experience. Is it worthy? Does it really make the difference?

RE: DM alongside Azotaemia

Stephen Courtney — Wed, 08 Jul 2015 18:37:37 GMT

Diabetic cats are massively pu/pd and have high glycosuria, high BG and high fructosamine. They are losing weight.

I agree everything has to start somewhere , but even if this cat is thinking about becoming diabetic, now is not the time to give insulin. There are several tests to take care of, urine including sediment exam and culture, taken by cystocentesis, would be top of the list. Blood pressure measurement next, then renal diet. Seems the urine protein:creatinine ratio is OK for now but that wants watching too.

Watch and wait, first do no harm. Acute onset diabetes won't kill the cat any time soon, but that insulin might.

RE: DM alongside Azotaemia

Mark Hedberg — Tue, 07 Jul 2015 08:43:51 GMT

http://www.langfordvets.co.uk/sites/default/files/Feline%20Update%20Autumn%202011%20revised%20030713.pdf

[quote]

Bacterial culture and sensitivity of the urine should ideally be performed in all cases, even if bacterial infection is rare in young cats. It should always be performed if uroliths or glucosuria are present, if concurrent systemic diseases are identified which predispose to urinary tract infections (see above), and in all cats aged 10 or older.[/quote]

RE: DM alongside Azotaemia

Catriona MacIntyre — Mon, 06 Jul 2015 20:37:05 GMT

After being caught out on a couple of feline cases, I never start insulin now without a fructosamine level.

Could there be a stressor at home? Or neighbouring cats?

RE: DM alongside Azotaemia

Anthony Dennison — Mon, 06 Jul 2015 11:31:11 GMT

Update on this case:

A urine sample showed glucosuria, the glucose curve I did in the practice had started at 20.1mmol/l, lowest it went was 16mmol/L. Decided to start on 1IU Caninsulin BID (0.33IU/kg), and the owner did a curve at home yday:

8.46: 11.2mmol/L (fed and given insulin)

10.50: 2.9mmol/L

13.12: 3.1mmol/L

14.49: 6.1mmol/L

17.30: 8.1mmol/L

20.05 8.6mmol/L (fed and given insulin)

22.13: 2.9mmol/L

With those results I'm stopping the insulin - but why is there glucosuria from a sample collected at home? Apparently he has been much more active since he started the insulin last week and is eating better. What's going on?!

Re: DM alongside Azotaemia

Kate Richardson — Mon, 29 Jun 2015 13:47:17 GMT

Simple approach- assuming the cat is 'well' - leave it a few days and then get the owner to collect a urine sample at home- if it is persistently hyperglycaemic there will still be glucose in the urine and you've ruled out the stress effect. Could still be due to renal tubular disease but unlikely to be hyperglycaemic in that case so measurement of bg at home will then help differentiate.

Re: DM alongside Azotaemia

Martin Atkinson — Mon, 29 Jun 2015 12:57:27 GMT

[quote user="Linda Filshie"]I've got a patient with CKD that developed DM in the last few months so it's certainly possible to get both conditions concurrently. [/quote]One of my own cats did he also had IBD and urolithiasis. I've yet to find anyone who makes a diabetic/renal/restricted protein/struvite diet - I guess there's not much call for it!

Re: DM alongside Azotaemia

Linda Filshie — Mon, 29 Jun 2015 12:51:49 GMT

I've got a patient with CKD that developed DM in the last few months so it's certainly possible to get both conditions concurrently. He's on k/d and caninsulin and seems to be heading towards remission at the moment.

Re: DM alongside Azotaemia

Anthony Dennison — Mon, 29 Jun 2015 12:26:38 GMT

There is also potential for this cat to have acromegaly - he is a big cat, with a big chin and at rest his tongue does sometimes stick out a little.

Re: DM alongside Azotaemia

Anthony Dennison — Mon, 29 Jun 2015 12:20:43 GMT

The teeth aren't terrible, but there is some tartar on the more caudal teeth. The cat had been drinking more, which the owner realised once she had thought about it (hindsight is good like that).

I'm showing her how to do a glucose curve at home with ear pricks today, and it allows me to do the curve to start with for more info, so we will see!

Re: DM alongside Azotaemia

Martin Atkinson — Mon, 29 Jun 2015 11:55:49 GMT

[quote user="Anthony Dennison"] I didn't do the dental after the results seen. I've got the cat in today to do a glucose curve, just to see what happens.[/quote]I suspect if it is that stressed your curve will not give you much further information - could you teach the owners to measure it at home? And how bad are the cats teeth? If it was just a cosmetic 'quiet day' dental fair enough but it is hardly going to do it any good if its got a mouth full of gingivitis/periodontitis. That could be part of the way to explaining your raised BUN.

Re: DM alongside Azotaemia

Anthony Dennison — Mon, 29 Jun 2015 11:41:07 GMT

[quote user="Martin Atkinson"]I would revisit the blood glucose/fructosamine in a couple of weeks when the added stress of the dental is not involved and put the cat on a moderately reduced protein diet like RCW Senior consult stage 2 although you haven't mentioned phosphate which is more important than BUN[/quote]

I didn't do the dental after the results seen. Urine was tested almost straight away. I've got the cat in today to do a glucose curve, just to see what happens.

Re: DM alongside Azotaemia

Mark Hedberg — Mon, 29 Jun 2015 10:51:59 GMT

I'd be suspicious of stress hyperglycemia, personally - the cats don't always have to be psychos to get an elevated BG.

Re: DM alongside Azotaemia

Martin Atkinson — Mon, 29 Jun 2015 10:51:28 GMT

If its fructosamine is normal I would tend to believe that at the moment given the frequency of stress hyperglycaemia in cats, albeit the glucose is a little higher than expected just for stress. You say there's no proteinuria but have you done a urine culture and how long was the urine taken before it was tested ? - the glycosuria could be due to bacterial action. I would revisit the blood glucose/fructosamine in a couple of weeks when the added stress of the dental is not involved and put the cat on a moderately reduced protein diet like RCW Senior consult stage 2 although you haven't mentioned phosphate which is more important than BUN. If that is elevated you may need a renal diet or phosphate binder. Don't forget K either.

There is a bit of a problem with managing a cat with CKD and DM as I tend to give DM cases a high protein low carbo diet which is obviously the opposite needed for CKD. You just have to manage the problem which is worst as a priority.