ISFM consensus guidelines on the practical management of diabetes mellitus in cats

Abstract

Practical relevance: Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats.

Clinical challenges: Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently--unless hypoglycaemia is encountered.

Evidence base: The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a consensus view on practical management of cats with DM based on available clinical data and experience. However, in many areas, substantial data are lacking and there is a need for better studies in the future to help inform and refine recommendations for the clinical management of this common disease.

Figure 1

Use of an insulin pen may improve the accuracy of dosing insulin

Figure 2

Diabetic cat with a continuous blood glucose monitor in place

Figure 3

Monitoring blood glucose from the marginal ear vein – a technique that owners can use at home

Figure 4

Blood glucose curves generated from the same cat at home (circles) and in the hospital (squares) 3 days apart from each other (cat received 2 U of insulin glargine on each occasion at t = 0).The cat (a 9-year-old, male neutered domestic shorthair, weighing 4.9 kg) had been diagnosed with diabetes 3 weeks previously and was fed a high protein, low carbohydrate diet. Clinical signs were well controlled and serum fructosamine concentrations had decreased by 200 umol/l.The two curves differ substantially from each other. The blood glucose concentrations of the hospital curve were substantially higher than those of the home curve, and were all above the target range. The majority of the blood glucose concentrations of the home curve were within the target range, although the nadir was too low (2.3 mmol/l). The high glucose concentrations in the hospital were attributed to stress. Because of the low nadir at home the insulin dose was slightly reduced and the cat continued to do well, demonstrating that blood glucose concentrations measured in the hospital may be altered by stress. Failure to recognise the effect of stress on blood glucose concentrations may lead to the erroneous assumption that the diabetic cat is poorly controlled. Home monitoring is, therefore, the preferred method to evaluate the glycaemic situation

Figure 5

Example of a glucose curve from a continuous blood glucose monitor

Figure 6

Example of an owner diary for a cat with DM