Diabetes in a cat- hard to stabilise

Re: Diabetes in a cat- hard to stabilise

listhestar — Tue, 12 Apr 2011 20:55:01 GMT

Hi everyone

Just to say I ran the blood from RVC and the cat has come up very high for the IGF. The cat is uninsured so I can not go any further. Just wanted to give everyone an update and say thanks for the help.

Lisa

Re: Diabetes in a cat- hard to stabilise

KathW — Fri, 28 Jan 2011 14:35:55 GMT

[quote user="listhestar"]

Think I will definately check for acromegaly. Would anyone else up the dose of insulin further or await acromegaly test first?

[quote user="KathW"]Carmel Mooney for advice and she was v helpful[/quote]- Kath- where is she based at?

[/quote]

Carmel is based at University College Dublin. I had heard her give some good lectures on DM in cats so I googled her and e mailed. I felt a bit cheeky but she was v nice and helpful. Perhaps try Martin's contact 1st?

I would look at RVC for blood test for acromegaly. It does seem to be free and there's possible follow up if +ve. We are too far away for that.

I would also increase the insulin another unit in the meantime whilst persuading the o to do more tests/waiting for results.

As others had said Cushings is also possible - generally associated with marked skin changes in cats ( but I suppose the generally ) means some have normal skin + hair coat!

My 1st cat with acromegaly at 1st had high fructosamine but glucose curve did go down to arund" 5" at 1 stage then shot back up to "20". This was early on after the diagnosis. Cats with acromegaly are supposed to be very insulin resistant so it didnt fit at that stage. I wonder what the blood results would have been it I'd tested at that point for acromegaly? It looks like something we'll all know more about in a few more years!!

Seen that cat again today for check up. It's on glargine 12 units bid weight and body condition stable but now can see that face size and shape are changing, heart murmur developed + more stertous resp noise. Still drinks more than normal and would eat +++if allowed. If glargine dose reduced signs worsen so we're keeping her at 12 units bid.

Good Luck and let us know what the outcome is.

Re: Diabetes in a cat- hard to stabilise

Kate Richardson — Fri, 28 Jan 2011 14:00:09 GMT

[quote user="Martin Atkinson"]If the cat is still very PU/PD, I would consider HAC as a potential complication and do a urine creatinine/cortisol ratio plus a low dose dex suppression test. [/quote]

I've just posted some info on feline HAC on another thread (hypostenuria in a 6year old cat) which may be helpful? Worth noting that a urine creatinine:cortisol ratio is only helping in ruling out HAC (ie if result is normal), if it is elevated, it doesn't mean the cat does have HAC. Also, the low dose dex suppression tests (0.01mg/kg dex iv) is unreliable as 20% of normal cats will fail to suppress or will escape suppression at 4-6hrs, so a more reliable test is to use the high dose dex (0.1mg/kg dex iv) but there is a grey zone.

Re: Diabetes in a cat- hard to stabilise

Martin Atkinson — Fri, 28 Jan 2011 12:15:45 GMT

[quote user="listhestar"]

How significant would you say the rasised spec Fpli is because there is a paper out there (can't remember who by-sorry) which suggests diabetic cats have higher levels of pli vs non diabetic. Think I will definately check for acromegaly. Would anyone else up the dose of insulin further or await acromegaly test first?

[/quote]

fPLI is fairly transient in cats after an acute bout of pancreatitis so if its persistently raised there may be some association with the DM but I honestly don't know. Although your cat isn't stabilised on 5iu insulin acromegalics usually need very much higher doses some as high as 60-80!!. If the cat is still very PU/PD, I would consider HAC as a potential complication and do a urine creatinine/cortisol ratio plus a low dose dex suppression test. Are there any other changes that may be suggestive of HAC especially skin/hair changes? I think you are probably justified in increasing your dose of insulin though slowly by a unit at time until you can rule out/in these other potential problems but obviously educate the clients on how to spot and deal with a hypo. In addition to Carmel Moody you could try Krista Visser't Hooft at VRCC her email is krista.visserthooft@vrcc.co.uk not surprisingly, tell her I put you up to it!

Re: Diabetes in a cat- hard to stabilise

listhestar — Fri, 28 Jan 2011 11:20:31 GMT

[quote user="KathW"]None of the above says to me that the cat is nearly stable[/quote]

Well thats certainly how I and the owner feel. I always worry about the possibility of smorygi effect as well so some people/books where suggesting dropping down the insulin which seems counterproductive. How significant would you say the rasised spec Fpli is because there is a paper out there (can't remember who by-sorry) which suggests diabetic cats have higher levels of pli vs non diabetic. Think I will definately check for acromegaly. Would anyone else up the dose of insulin further or await acromegaly test first?

[quote user="KathW"]Carmel Mooney for advice and she was v helpful[/quote]- Kath- where is she based at?

Thanks everyone, nice to get input once again from the wealth of knowledge out there!

Lisa

Re: Diabetes in a cat- hard to stabilise

KathW — Thu, 27 Jan 2011 09:59:54 GMT

[quote user="listhestar"]

Over the course of the time of gaining this case (and my colleague before me) we have done routine biochem, haematology, urine cultures, t4, felv and fiv testing. All been ok yet the cat is not stabilising on caninsulin currently 5 units twice a day (approx just under 1 unit/kg). Fructosamine remains above 600, the curves when done don't see the cat reach a nidir lower than 20 (but stress could contribute to that). Her drinking is still high and she still has the neuopathy (although stronger than first diagnosed). Thanks guys

[/quote]

None of the above says to me that the cat is nearly stable. I would test for acromegaly. I had a similar case and it turned out to have acromegaly. I asked Carmel Mooney for advice and she was v helpful. She says she now tests for this a lot sooner than she used to. seems to be it's maybe a bit more common than we thought so in cases such as this it would seem reasonable to check fairly early on.

We now have 2 cats diagnosed with acromegaly in our practice - both started out being treated as normal diabetics would but didn't respond well. The 2nd one got tested for acromegaly a lot sooner than the 1st as we were suspicious due to continually high fructosaminewith increasing insulin doses flattish but high (18-20's) glucose curve etc.

Re: Diabetes in a cat- hard to stabilise

Stephen Ashman — Wed, 26 Jan 2011 20:48:10 GMT

[quote user="Catherine Blackman"]Think it's the alphatrac we've got.[/quote]

We've had the same problem Catherine. We had to abandon a curve one day because we only realised this after a good few samples! It has also happened at other times.

Re: Diabetes in a cat- hard to stabilise

Michael Woodhouse — Wed, 26 Jan 2011 20:11:28 GMT

I was taught 2units/kg was the definition of insulin resistance. I'd be increasing the insulin dose.

In humans it has been found if you squeeze the prick site it can affect the glucose level.

I have tested our human glucometer [Medisense Optium Exceed, can also measure ketones] and jugular samples match ear prick or claw cut short. It's within about 15% of the external lab [only three samples IIRC] which is accurate enough.

Re: Diabetes in a cat- hard to stabilise

Catherine Hemingway — Wed, 26 Jan 2011 20:06:20 GMT

Think it's the alphatrac we've got. Tested it many times ie taking a cephalic sample and testing on glucometer and biochem machine which are always the same and ear sample taken at the same time tested on glucometer is always different. Can't be sample size as glucometer sucks up the same amount each time. Has happened many times, different animals and different vets/nurses taking the samples, weird.

Re: Diabetes in a cat- hard to stabilise

Martin Atkinson — Wed, 26 Jan 2011 19:34:15 GMT

[quote user="Catherine Blackman"]

I had a diabetic cat recently that we stabilised and then suddenly after 3months he became unstable again. Turned out he had acromegaly so well worth testing for and the RVC do test for free.

As a slight aside however picking up on Martin's point above regarding pricking ears for BG curves: we have one of the 'animal glucometers' (sorry can't think of the proper name) and have found that it gives you completely different readings if you perform an ear prick or a cephalic sample. We have contacted the company and they can't explain it, have tried 3 different glucometers of that particular type and same with all of them, hence practice policy of cephalic samples only for BG curves

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Can't say I've had that problem and we use the Alphatrac. Ear prick samples certainly match cephalic samples tested on a Vetscan biochemistry analyser. Maybe its something to do with sample size you're using.

Re: Diabetes in a cat- hard to stabilise

Catherine Hemingway — Wed, 26 Jan 2011 19:30:54 GMT

I had a diabetic cat recently that we stabilised and then suddenly after 3months he became unstable again. Turned out he had acromegaly so well worth testing for and the RVC do test for free.

Re: Diabetes in a cat- hard to stabilise

Martin Atkinson — Wed, 26 Jan 2011 19:08:27 GMT

Its unlikely to be acromegaly if its nearly stabilised on 5iu bid most acromegalics are on very much higher doses than that but if the test is free you might as well go for it. There is no practical treatment for acromegaly anyway other than to just increase the dose of insulin. You can't rule out somogyi effect with a nadir or 20 unless you can see a nice flat curve although admittedly its unlikely. I would think its the pancreatitis that giving you a relative insulin resistance but some DM cats are also HAC and that could be giving rise to the hind leg weakness as IMO this is not a common complication of pure unstablised DM cats. Can you get the client to perform a curve at home? - some are quite adept at pricking an ear vein if you clip it for them and show them how to use a lancette. If all else is equal you may have more success with Glargine (Lantus) than Caninsulin and it is relatively inexpensive if you get the 3ml cartridges which is designed for the human pen. Downside I've found to Lantus is that as it is 100iu/ml the margin of error is much greater due to lower dose volume than Caninsulin and the 0.3ml syringes you need to overcome that problem are so fine that it is difficult to be sure the needle has gone in! I've had several problem DM cats and dogs recently and I'm rapidly coming to the conclusion that it is impossible to stabilise them. The more I monitor the more unstable they become, when I didn't bother so much they were much more stable because I didn't know they were unstable! Its illogical to expect to perfectly stabilse our patients on one or two doses of long acting insulin a day when a human diabetic is constantly testing, adjusting doses juggling with short and long acting insulin to accomodate diet and excercise differences and still can't get it right half the time.

Re: Diabetes in a cat- hard to stabilise

listhestar — Wed, 26 Jan 2011 18:37:26 GMT

[quote user="Mark Holmes"]

London are doing a test for IGF as they have found that about 30% of cats tested with diabetes actually have acromegaly. If persistant hypergycaemia is a problem I would probably check for that. Speak to RVC in london about a test....ifs free as part of a monitoring program.

[/quote]

Thanks- I saw that the other day. I think RVC will be my next port of call.

Lisa

Re: Diabetes in a cat- hard to stabilise

Mark Holmes — Wed, 26 Jan 2011 18:19:20 GMT