Feline diabetes mellitus: clinical use of long-acting glargine and detemir

Abstract

Practical relevance: Diabetes mellitus is a common endocrine disorder in feline practice, affecting approximately 1 in 200 cats. The majority of diabetic cats have type 2 diabetes mellitus, which results from a combination of peripheral insulin resistance and a progressive reduction in insulin production.

Clinical challenges: While usually easy to diagnose, management of diabetes mellitus presents a number of challenges for practitioners and clients alike. Practitioners must decide on diet, insulin type and dose, monitoring method and intensity, and concomitant therapy, which will vary based on individual patient and client needs, and geographic location. Practitioners may also encounter patients with diabetic ketoacidosis or other diabetic complications, and patients with multiple concurrent diseases. Clients may be challenged by the substantial time and financial commitment involved in owning a diabetic cat.

Audience: Understanding the pathophysiology, optimal treatment protocols and current goals of diabetes management will benefit practitioners managing diabetic cats. This article reviews the most current management plans for feline diabetics. It places particular emphasis on best practice for achieving diabetic remission, which is an attainable goal in the majority of newly diagnosed diabetic cats.

Evidence base: The information in this article is drawn from the recent human and veterinary literature, including prospective and retrospective studies. The body of prospective clinical data on the use of newer, long-acting insulins (glargine and especially detemir) in cats is limited, but growing.

Figure 1

Obesity and older age (>8 years of age) are the most important risk factors for diabetes

Figure 2

Burmese cats are predisposed to diabetes, and the highest risk is in overweight senior Burmese cats

Figure 3

Indoor, inactive cats have an increased risk of diabetes

Figure 4

Glargine (Lantus) is a long-acting analogue insulin associated with high remission rates in cats

Figure 5

Detemir (Levemir) is a long-acting analogue insulin associated with high remission rates in cats

Figure 6

(a) Use of a lancet (AlphaTRAK; Abbott) to obtain blood from the pinna of a cat. (b) Drop of blood on the ear margin. (c) Measuring blood glucose using a meter calibrated for feline blood (AlphaTRAK; Abbott). Such meters, which require only a small volume of blood (eg, 0.3 μl), facilitate successful home blood glucose monitoring in cats. Courtesy of M Reeve-Johnson

Figure 7

(a,b) Use of a lancet to obtain a blood sample from the edge of a foot pad. Courtesy of M Reeve-Johnson

Figure 8

A drop of blood being obtained from the pisiform pad following use of a lancing device designed for home monitoring. Reproduced with permission from S. Ford. In: Rand JS (ed). Clinical Endocrinology of Companion Animals. Wiley-Blackwell, 2013; 16: 169–190

Figure 9

Day 1, day 3 and day 10 blood glucose concentrations measured over 12 h in eight newly diagnosed diabetic cats treated with glargine at 0.5 U/kg twice daily if blood glucose >20 mmol/l (360 mg/dl). Note the range of differing responses

Figure 10

Mean blood glucose concentrations measured over 12 h in six newly diagnosed diabetic cats on days 1–3 and 10 after initiation of treatment with glargine at an initial dose of 0.5 U/kg twice daily (blood glucose >20 mmol/l; 360 mg/dl). Note how rapidly mean blood glucose decreases over time