Being plus-sized predisposes cats to diabetes mellitus. |
The International Society for Feline Medicine (ISFM) has
just released guidelines on management of diabetes mellitus in cats, published
in the Journal of Feline Medicine andSurgery.
The full text document is available for free and if you
are an owner of a diabetic cat, or a veterinarian or student, these are worth
downloading and reading in full.
Like all consensus statements this was put together by a
panel of specialists who review the available literature and make
recommendations based on current knowledge. Therefore the recommendations may
change as further evidence becomes available. But these are definitely very
helpful guidelines for those who need to make decisions around the management
of diabetic cats.
Feline diabetes is on the rise, possibly due to an
increase in the incidence of obesity, which is likely a result of ad lib access
to premium diets and reduced outdoor access without associated reduction in
calories.
The average age of survival of a diabetic cat is 13-29
months after diagnosis, however they tend to live longer if their diabetes is
well controlled. I have certainly treated some cats that have lived for five
years and over with diabetes.
Most cats with diabetes have a type of diabetes similar
to type 2 diabetes mellitus (DM) in humans = due to pancreatic beta cell
dysfunction and insulin resistance (fat increases insulin resistance, hence
obesity is a factor). Aside from obesity, other risk factors include: being
over 7 years old, being Burmese, being indoors and inactive, being male and
desexed, and being on drugs that impact insulin metabolism, e.g.
corticosteroids.
The classic clinical signs of diabetes are polyuria
(urinating a lot), polydipsia (drinking a lot), polyphagia (eating a lot),
fatigue, and weight loss. Some cats also appear weak, wobbly or flat, and those
with diabetic ketoacidosis or pancreatitis – or other concurrent disease like
renal disease or hyperthyroidism - may be inappetent and vomiting.
Diagnosis is based on persistent high blood and high
urine glucose (hyperglycaemia and glucosuria respectively). But the panel
recommend performing a complete physical examination, complete blood count,
serum biochemistry panel, serum fructosamine (this gives an indication of the
average blood glucose over the previous week), serum thyroxine concentration
and feline pancreatic lipase tests due to the high prevalence of concurrent
disease like hyperthyroidism and pancreatitis (your pancreas is where those
insulin producing beta cells live so it’s important in the aetiology of DM).
According to the panel, there are two key aims of
treating cats with insulin:
- To control blood glucose by keeping it under 14mmol/L (252mg/dl for our Northern hemisphere counterparts) for as much of a 24 hour period as possible;
- To avoid clinically significant hypoglycaemia as this can be life-threatening.
Currently there is very little evidence supporting the
use of oral hypoglycaemic agents to treat DM in cats. Use of a long-acting
(e.g. glargine or detemir) injectable insulin is preferred. Two daily
injections twelve hours apart may be very hard for owners to comply with. While
this is ideal, the panel recommend allowing some flexibility with doses given
12 hrs +/- 2 hours apart, and missing doses outside of this window if
occasional.
The guidelines go into detail on initial and long-term
management of cats with DM, but one of the things strongly recommended is home
monitoring of cats. While previously there have been mixed reports about home
blood glucose monitoring, the panel supports this, along with assessment of
daily wellbeing, daily water intake, daily urine production, weekly body weight
and body condition score, urine glucose (using urine dipsticks) and where
possible blood glucose.
They also recommend very regular in clinic monitoring.
After initial diagnosis,
cats should be re-evaluated in weeks 1,2-3, 6-8, 10-12
and 14-16 and then every 1-4 months (a good reason to invest in pet insurance).
There are now excellent resources for cat owners that can
aid in monitoring diabetics via the iCatCare YouTube channel, so you can check
out these very helpful links below.
Reference
Sparkes AH, Cannon M, Church D, Fleeman L, Harvey A,
Hoenig M, Peterson ME, Reusch CE, Taylor S & Rosenberg D (2015) ISFM
consensus guidelines on the practical management of diabetes mellitus in cats. Journal of Feline Medicine and Surgery
17(3):235-50. Doi: 10.1177/1098612X15571880