Can lactulose cause diabetes?

RE: Can lactulose cause diabetes?

Gillian Mostyn — Thu, 26 Mar 2020 15:16:01 GMT

Thank you so much to you both for your time. Very helpful!

RE: Can lactulose cause diabetes?

Christopher Scudder — Thu, 26 Mar 2020 11:32:05 GMT

It's always diffiucult to know if a glucose of 8 is something to take note of as could just be stress in a cat. Stress hyperglycaemia typically resolves after 6 hours or so, but it's interesting that that is technically a higher value than normal and six weeks later the cat was overly diabetic. This could have been the first sign of glucose intolerance.

Hospitalisation is one option, otherwise as Andrew suggested go slow and low with your insulin dose. Even if the owner cannot measure the cat's glucose at home, you could use urine glucose to monitor for progression toward ketosis or persistent negative urine glucose which might prompt lowering the insulin dose. The other option would be to see if a FreeStyle Libre worked in this individual cat (they are hit and miss at the best of times and even more so in cats).

Good luck.

RE: Can lactulose cause diabetes?

Gillian Mostyn — Wed, 25 Mar 2020 22:54:41 GMT

[quote userid="5836" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/28985/can-lactulose-cause-diabetes/220870"]So, in short, it is more likely that the colonic dysmotility was an early symptom of diabetes rather than lactulose caused hyperglycaemia.[/quote]

Yes, that was my first thought. But it's blood glucose was 8 at point of diagnosis so I assumed unlikely?

[quote userid="5836" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/28985/can-lactulose-cause-diabetes/220870"]How to treat. Well I think diet alone will rarely be enough because of beta cell toxicity to hyperglycaemia. So insulin will be needed, and it'll be a case of trying to get owners on board with a protoc thay works for them. [/quote]

I'm sure the owners will be very keen to treat in whatever way is best. I'm just worried about the implications if starting insulin therapy at the moment. I've already suggested hospitalisation is likely to be needed initially to reduce owner journeys and interaction.

[quote userid="5836" url="~/001/veterinary-clinical/small-animal/medicine/f/expert-help/28985/can-lactulose-cause-diabetes/220870"]For alternative to lactulose, I commonly use cisapride[/quote]

Cidapride was tried initially with no improvement, but I guess could be tried again now the cat is more stable wrt constipation.

Thank-you

RE: Can lactulose cause diabetes?

Christopher Scudder — Wed, 25 Mar 2020 20:50:47 GMT

Hiya,

Lactulose is used to managed colonic motility disorders in human diabetics and has not shown to increase blood glucose in humans even when given in high doses to individuals with glucose impairment. So, in short, it is more likely that the colonic dysmotility was an early symptom of diabetes rather than lactulose caused hyperglycaemia.

How to treat. Well I think diet alone will rarely be enough because of beta cell toxicity to hyperglycaemia. So insulin will be needed, and it'll be a case of trying to get owners on board with a protoc thay works for them.

For alternative to lactulose, I commonly use cisapride plus additional fibre such as pumpkin for mega colon cases.

Good luck.

RE: Can lactulose cause diabetes?

Gillian Mostyn — Wed, 25 Mar 2020 20:27:44 GMT

Thank you...that's great.

I am a locum so only met this cat today, and won't be back there. However, I told the owner I'd be asking here and I plan to ring the owner and the practice tomorrow to discuss him and his care, especially with the other vet, so I can pass on your advice...thanks.

I told the owner to start to wean him (quickly) off lactulose so it would be great if the problem resolves. I'll try to chase up and let you know.

RE: Can lactulose cause diabetes?

Andrew Kent — Wed, 25 Mar 2020 19:51:59 GMT

Hi Gillian,

As you say, in theory lactulose should not cause hyperglycaemia and we consider it safe in diabetics but I have occasionally (anecdotally) heard of individual cats that do become hyperglycaemic on treatment. I guess if that were the case you should see any increases resolve rapidly after stopping and could use Miralax (or an alternative polyethylene glycol) powder rather than lactulose? But more likely this is unrelated.

New diabetics are a challenge at the moment and I have been involved over the last few days with trying to put together some pragmatic guidance for these kind of patients in the current climate. I agree a change in diet would be sensible but as a hands off approach one could consider starting a low dose of insulin (just enough to try to avoid a ketoacidotic crisis) and getting the owners to dipstick the urine at home to make sure remains glycosuric on the first sample of the day.

Andy