Diabetic cat

Re: Diabetic cat

Kate Richardson — Fri, 10 Sep 2010 17:06:09 GMT

PS Martin Great article in vet times- made me LOL!!!!!

Re: Diabetic cat

Mark Holmes — Fri, 10 Sep 2010 14:47:42 GMT

Can I ask which glucometer you are using? Human glucometers are wildly inaccurate for testing cats and dogs, (about 30% I think) We have one of the alphatrak recalibrated ones and it has made glucose monitoring much better.

Re: Diabetic cat

Martin Atkinson — Fri, 10 Sep 2010 14:42:59 GMT

Thanks Kate I went to a seminar on DM about 3 months ago and learned much of what you have said above. I like the webinars but tend to look at them in the archive at my leisure so I may look that one up, I forgot it was on yesterday - doh! My outlook on Somogyi effect especially chronic overswings has dramatically changed and it could easily be misinterpreted as a poor-response curve by the unwary. The owner is going to do a home curve next week to try and get the 2nd 12 hours we cant do here but I'm pretty certain this cat is not stressed while here - she's spent quite a bit of her short life in our kennels and seems very laid back indeed she was more stressed when forced to stay in one room with her adolescent kittens by the CP fosterer. I just hope we can get to the bottom if it before CP funds and patience run out and she's a PTS when she has her next episode of DKA if we cant control it.

Re: Diabetic cat

Kate Richardson — Fri, 10 Sep 2010 12:49:53 GMT

Hi Martin, excellent webinar last night by Martha Cannon on Feline Diabetes, worth looking at if you can, I think it is going to be put on website as a freebie www.thewebinarvet.com , but don't quote me on that, but prob won't be on there till Monday. Think you have done the right thing by dropping insulin dose significantly, some cats are very sensitive to insulin, and she obviously did respond initially, suggesting insulin resistance less likely? Best not to alter insulin dose more than every 3-4 days, not daily in cats. Somorgi overswing can last for 3 days in some cases, esp if insulin dose is too high and is continued, cos as soon as insulin causes drop in glucose levels, will get another rapid upswing. Somorgi due to speed of drop in gluc levels not due to actual level it drops too. Think the metronidazole tx is prob just a coincidence? DM may be more due to the pre-existing disease, possibly pancreatitis as you suggest. One would hope in such a young cat the endocrine pancreas is not completely obliterated and there would be some hope for remission. Re Liver disease I would have thought that would cause hypoglycaemia not hyperglycaemia. But is there any other pre-existing or concurrent disease that could be affecting insulin response? The other thing worth considering is home monitoring- teach the owner/carer to do ear pricks and use a glucometer, will prob work out much more cost effective and also minimises/eliminates stress hyperglycaemia- O than then report in with gluc curve. Hope that helps.

Re: Diabetic cat

Martin Atkinson — Thu, 09 Sep 2010 19:30:21 GMT

[quote user="Martin Jones"]

I know, I know this is pedantic, but have you done any liver function tests per se, or are we talking about routine biochem? It is mooted that shunts might cause hyperglycaemia - certainly post-prandial rise tends to be higher and longer, but absolute persistence I wouldn't be sure about (like you, I'm heavily into straw grasping territory here, and having assumed that anything I would normally suggest has been considered, I might as well go off on a mighty tangent). Equally pedantic would be to point out 'mentation', but then you ARE 60 and one does have to make allowances.......

CRI - you were talking about insulin infusion, so I thought you'd been on a constant rate infusion.

I do also remember having a conversation with a lab bod about high fructosamine in cats, and the (behind the scenes) thoughts were that just as acute stress can cause hyperglycaemia, and so measures of blood glucose are always difficult to trust unless low, so a period of stress might cause highER levels of fructosamine - but how high was it in this case?

Bile acid stim? Ammonia?

[/quote]

So many questions my brain takes time to function at 60!! OK so I did give a CRI of insulin when she was admitted in DKA. I haven't done a liver function test but am now planning to do post prandial bile acids and also a TLI when she comes in for her next glucose curve. Kitten food wouldn't be exactly ideal then if she has a shunt would it?! Fructosamine was 440 which is not as high as cats in DKA usually is but this was all pretty acute onset and she is a very laid back cat so too high for stress I'd think.

Re: Diabetic cat

Kirsten Simpson — Thu, 09 Sep 2010 19:02:56 GMT

Have you tested for IGF-1? She probably is FAR too young for acromegaly but it's always an option in an uncontrolled/odd diebetic?

Re: Diabetic cat

Martin Jones — Thu, 09 Sep 2010 18:10:41 GMT

[quote user="Martin Atkinson"]

Liver function and cat's mentition appear normal so I hadn't considered a shunt but would that cause a persistant hyperglycaemia and I don't want to appear thick but what's CRI in this context?

[/quote]

CRI - you were talking about insulin infusion, so I thought you'd been on a constant rate infusion.

Bile acid stim? Ammonia?

Re: Diabetic cat

Martin Atkinson — Thu, 09 Sep 2010 17:10:31 GMT

[quote user="Malcolm Ness"]

Are attractive animals (?? people) with interesting problems more deserving of help than ugly creatures with boring disease?

[/quote]

You may have a point Malcolm: I believe grossly obese people and smokers should not be treated on the NHS for conditions related their condition/habit (although as a true hypocrite I think I should get treatment for injuries related to my sporting activities) so perhaps we should include ugly people as well.

Re: Diabetic cat

Martin Atkinson — Thu, 09 Sep 2010 16:43:49 GMT

[quote user="Martin Jones"]

Probably been discounted quite a way in the past, but possibility of a shunt? I'd agree with your thoughts on overswing with insulin bolus, set against the apparent response to a CRI - ditto with the increase in ketone bodies even with lower glucose levels when off the insulin. Have you done any insulin assays, and what diet is the cat on?

Sounds like an episode of House - are you beating people with your walking stick yet?

Martin

[/quote]

Liver function and cat's mentition appear normal so I hadn't considered a shunt but would that cause a persistant hyperglycaemia and I don't want to appear thick but what's CRI in this context? I also hadn't considered insulin assays but thats not an option while we're still fiddling with insulin as a treatment and I've got the cat on wet kitten food (although because she prefers the dry the CP person is feeding her some of that) to achieve a high protein/lowcarbohydrate diet.

I may be 60 but I don't need a stick yet!

Re: Diabetic cat

Ruta — Thu, 09 Sep 2010 15:25:40 GMT

I will mark it on my notebook. Thanks, Mark, for deepened my knowledge. :)

Ruta

Re: Diabetic cat

Mark Holmes — Thu, 09 Sep 2010 13:27:35 GMT

There is no glucose elevation in diabetes insipidus, it is not related to insulin or the pancreas and not related to diabetes mellitus at all. Diabetes insipidus is associated with an ADH deficiency.

Re: Diabetic cat

Ruta — Thu, 09 Sep 2010 12:10:55 GMT

I might be wrong, but what about diabetes insipidus?

Ruta

Re: Diabetic cat

Martin Jones — Thu, 09 Sep 2010 10:26:40 GMT

Sounds like an episode of House - are you beating people with your walking stick yet?

Martin

Re: Diabetic cat

Malcolm Ness — Thu, 09 Sep 2010 10:11:52 GMT

[quote user="Martin Atkinson"]a lovely little cat, plus I can't resist a challenge[/quote]

There's a good topic for a CertAVP reflective essay!!

Are attractive animals (?? people) with interesting problems more deserving of help than ugly creatures with boring disease?

Re: Diabetic cat

Hannah Wynne Richards — Thu, 09 Sep 2010 10:01:12 GMT

Good luck Martin Sorry I can't offer a miracle cure

Wynne

Re: Diabetic cat

Martin Atkinson — Thu, 09 Sep 2010 09:04:42 GMT

Such cynicism Michael and Gillian! Sometimes even for us hard bitten realists the heart rules the head and this is such a lovely little cat, plus I can't resist a challenge so I have given a lot of my time for free on top of the already considerably reduced charitable rate charges - I can't give up on her yet. Even the specialist endocrinologists and guys at Bristol are helping as a favour so I'm duty bound to continue. I'd like to say I can then rest easy in my bed at night but I can't because I even wake up feeling guilty I could be doing more.

Re: Diabetic cat

Gillian Mostyn — Wed, 08 Sep 2010 20:45:07 GMT

On this rare occasion Michael, I might agree...... :-)

Re: Diabetic cat

Michael Woodhouse — Wed, 08 Sep 2010 20:35:50 GMT

[quote user="Martin Atkinson"]she is under the care of the CP so funds and investigative possibilities are limited[/quote]

People are going to call me evil and mercenary but wouldn't it be better to put this cat to sleep and use the CP's money to help many more cats?

[I await the backlash and red stars]

Re: Diabetic cat

Mark Holmes — Wed, 08 Sep 2010 13:23:56 GMT

One of our nurses' cats developed transient diabetes at 1 year old. So I have come across it early, I cannot however explain the response to insulin, However if you use idexx 01937 544000 laboratory their internal medicine person Charlotte Davies available 12-4pm is wonderfully helpful and my favorite guru when in a pickle. I think I keep her employed!