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. 2018 May;32(3):978-985.
doi: 10.1111/jvim.15134. Epub 2018 Mar 30.

Glucose concentrations after insulin-induced hypoglycemia and glycemic variability in healthy and diabetic cats

Eric Zini  1   2   3 , Elena Salesov  1 , Perrine Dupont  1 , Laura Moretto  1 , Barbara Contiero  2 , Thomas A Lutz  4 , Claudia E Reusch  1
Affiliations

Glucose concentrations after insulin-induced hypoglycemia and glycemic variability in healthy and diabetic cats

Eric Zini et al. J Vet Intern Med. 2018 May.

Abstract

Background: Little information is available about posthypoglycemic hyperglycemia (PHH) in diabetic cats, and a causal link between hypoglycemia and subsequent hyperglycemia is not clear. Fluctuations in blood glucose concentrations might only represent high glycemic variability.

Hypothesis: Insulin induces PHH in healthy cats, and PHH is associated with poorly regulated diabetes and increased glycemic variability in diabetic cats.

Animals: Six healthy cats, 133 diabetic cats.

Methods: Insulin (protamine-zinc and degludec; 0.1-0.3 IU/kg) administered to healthy cats. Blood glucose curves were generated with portable glucose meter to determine the percentage of curves with PHH. Data from insulin-treated diabetic cats with blood glucose curves showing hypoglycemia included data of cats with and without PHH. Post-hypoglycemic hyperglycemia was defined as blood glucose concentrations <4 mmol/L followed by blood glucose concentrations >15 mmol/L within 12 hours. Glycemic variability was calculated as the standard deviation of the blood glucose concentrations.

Results: In healthy cats, all insulin doses caused hypoglycemia but PHH was not observed; glycemic variability did not differ between insulin preparations. Among diabetic cats with hypoglycemia, 33 (25%) had PHH. Compared with cats without PHH, their daily insulin dose was higher (1.09 ± 0.55 versus 0.65 ± 0.56 IU/kg; P < .001), serum fructosamine concentration was higher (565 ± 113 versus 430 ± 112 µmol/L; P < .001), remission was less frequent (10% versus 56%; P < .001), and glycemic variability was larger (8.1 ± 2.4 mmol/L versus 2.9 ± 2.2 mmol/L; P < .001).

Conclusions and clinical importance: Insulin-induced hypoglycemia did not cause PHH in healthy cats but it occurred in 25% of diabetic cats with hypoglycemia, particularly when diabetes was poorly controlled. Glycemic variability was increased in cats with PHH.

Keywords: cat; diabetes mellitus; endocrinology; pancreas.

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Figures

Figure 1
Figure 1
Blood glucose curves showing hypoglycemia in healthy cats (2 cats treated with PZI and 1 treated with ID were excluded because received a meal to correct hypoglycemia) treated with PZI at 0.1 (A), 0.2 (B), and 0.3 IU/kg (C) or ID at 0.1 (D), 0.2 (E), and 0.3 IU/kg (F). Median and range are shown for each time point
Figure 2
Figure 2
Scatter plots of blood glucose curves in diabetic cats with posthypoglycemic hyperglycemia (A) and without PHH (B). The gray box depicts the glucose concentrations between 4 and 15 mmol/L. Means are shown as horizontal bars in each scatter plot
Figure 3
Figure 3
Scatter plots of daily insulin dose in diabetic cats with PHH and without PHH. Means are shown as horizontal bars in each scatter plot
Figure 4
Figure 4
Scatter plots of serum fructosamine concentrations in diabetic cats with PHH and without PHH. Means are shown as horizontal bars in each scatter plot
See this image and copyright information in PMC

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