Treatment of Feline Diabetes

Marshall, R.D., J.S. Rand, and J.M. Morton, Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins. Journal of Feline Medicine & Surgery, 2009. 11(8): p. 683-691.

Diabetes mellitus is a moderately common disease in cats. The most effective and reliable treatment is insulin therapy to achieve glycemic control. The authors’ study compared the glycemic control and remission possibilities in 24 newly diagnosed diabetic cats. The cats were treated twice daily with either glargine, protamine zinc (PZI), or lente insulin along with being fed a low carbohydrate-high protein canned food. The primary finding was that for newly diagnosed diabetic cats, treatment with glargine resulted in a higher probability of remission compared to PZI or lente insulin. Better glycemic control of cats after 17 days of treatment with glargine was noted and based on lower mean blood glucose concentrations. By day 112, 8 of 8 cats treated with glargine achieved remission while 2/8 in the lente group and 3/8 in the PZI group had achieved remission. None of the glargine-treated cats exhibited signs of hypoglycemia while 3 cats in the other groups developed clinically severe hypoglycemia. The study indicates that twice-daily treatment with glargine insulin may deliver better glycemic control and possibility of remission than similar treatment with lente or PZI insulin. The authors note that good glycemic control soon after diagnosis with diabetes mellitus is associated with an increased probability of remission and this should be the goal of insulin therapy. [VT]
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Related articles:
Hall, T.D., et al., Effects of diet on glucose control in cats with diabetes mellitus treated with twice daily insulin glargine. Journal of Feline Medicine & Surgery, 2009. 11(2): p. 125-130.
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Weaver, K.E., et al., Use of glargine and lente insulins in cats with diabetes mellitus. J Vet Intern Med, 2006. 20(2): p. 234-8.
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Diabetes and Glucocorticoids in Cats

Lowe, A. D., T. K. Graves, et al. (2009). "A pilot study comparing the diabetogenic effects of dexamethasone and prednisolone in cats." J Amer Anim Hosp Assoc 45(5): 215-224.

One of the most common endocrine diseases in the cat is diabetes mellitus. Glucocorticoids are one of the most prescribed classes of drugs in veterinary medicine and there is little known about the safety profiles of these drugs in cats. Glucocorticoids carry a risk of side effects in most species, although cats have been considered resistant to many of the deleterious effects. This study followed 14 cats that received daily prednisolone (4.4 mg/kg, PO) or dexamethasone (0.55 mg/kg, PO) for 56 days. The doses were considered clinically equipotent. Serum fructosamine and urine glucose were measured on days 0, 28, and 56. In addition, insulin sensitivity, glucose tolerance, and peak insulin secretion were measured in each group before and at the end of the glucocorticoid adminstration. The data suggested that dexamethasone treatment, compared to prednisolone, results in greater fructosamine concentrations, greater decreases in insulin sensitivity, a lesser degree of insulin secretion from pancreatic beta-cells in the face of higher glucose and fructosamine concentrations, and a greater prevalence of glucosuria. These results support the hypothesis that dexamethasone may be a more potent inducer of a pre-diabetic or diabetic state than an equivalent dose of prednisolone. [VT]
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Related articles:
Lowe, A. D., K. L. Campbell, et al. (2008). "Clinical, clinicopathological and histological changes observed in 14 cats treated with glucocorticoids." Vet Rec 162(24): 777-83.
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Lowe, A. D., K. L. Campbell, et al. (2008). "Glucocorticoids in the cat." Vet Dermatol 19(6): 340-7.
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Recombinant PZI Insulin for Diabetic Cats

Nelson RW, Henley K, Cole C; the PZIR Clinical Study Group. Field safety and efficacy of protamine zinc recombinant human insulin for treatment of diabetes mellitus in cats. J Vet Intern Med. 2009 Jul;23(4):787-793.

This study was a prospective, uncontrolled clinical trial performed to evaluate the effects of protamine zinc recombinant human insulin (PZIR) on control of glycemia in cats with newly diagnosed or poorly controlled diabetes mellitus. One hundred thirty-three cats were enrolled in the study, consisting of 120 newly diagnosed and 13 previously treated diabetics. Cats were treated twice daily with PZIR for 45 days. Control of glycemia was assessed on days 7, 14, 30, and 45 by evaluation of changes in water consumption, frequency of urination, appetite, and body weight, serum fructosamine concentration, and blood glucose concentrations determined 1, 3, 5, 7, and 9 hours after administration of PZIR. Based on the criteria used to judge success of PZIR treatment, 113 (85%) of 133 diabetic cats, including 9 previously treated, poorly controlled diabetic cats, attained good diabetic control by day 45 of the study. Hypoglycemia (blood glucose nadir <80 mg/dL) was the only consistent problem with PZIR. The study cats also had a significant increase in mean body weight by the end of 45 days. Results of this study support using low dosages of insulin (0.22 U/kg) initially in newly diagnosed diabetic cats and adjusting the dosage of PZIR based on the response to treatment and results of blood glucose and serum fructosamine concentrations. The study supports the conclusion that PZIR is effective in controlling glycemia in diabetic cats and can be used as an initial treatment or as an alternative in poorly controlled diabetic cats that do not respond to treatment with other insulin preparations. [VT]
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Related articles:
Michiels L, Reusch CE, et al. Treatment of 46 cats with porcine lente insulin: a prospective, multicentre study. J Feline Med Surg. 2008 Oct;10(5):439-51.
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Martin GJ, Rand JS. Control of diabetes mellitus in cats with porcine insulin zinc suspension. Vet Rec. 2007 Jul 21;161(3):88-94.
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Treatment of Feline Diabetes with Diet and Insulin

Hall, T. D., O. Mahony, et al. (2009). "Effects of diet on glucose control in cats with diabetes mellitus treated with twice daily insulin glargine." Journal of Feline Medicine & Surgery 11(2): 125-130.

Diabetes mellitus is a common feline disease and is treated with a combination of dietary therapy and insulin. Insulin glargine (Lantus, Sanofi-Aventis) is a long-acting recombinant human insulin that is frequently used to treat diabetic cats. The purpose of this study, from Tufts Cummings School of Veterinary Medicine, was to compare a low carbohydrate/high protein (LCHP) diet to a non-prescription control diet in diabetic cats receiving insulin glargine twice daily. Over the 10-week trial, 6 cats were given the LCHP diet (DM Dietetic Management Feline Formula dry & canned, Nestle Purina) and 6 cats were given control diets (Pro Plan Adult Cat total Care Chicken and Rice dry, Nestle Purina and Friskies Special Diet Turkey & Giblets Dinner canned, Nestle Purina). Re-evaluations (blood glucose curves, serum fructosamine, and assessment of clinical signs) were performed at weeks 1, 2, 4, 6, and 10. Using insulin glargine twice daily and frequent monitoring, all cats in both groups did well. The main difference between the two groups was that the cats fed the LCHP diet had significantly lower serum fructosamine levels compared to the cats on the control diets. The clinical significance of this is unknown as all cats in both diet groups achieved good glycemic control. [SL]
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Related articles:
Marshall, R. D., J. S. Rand, et al. (2008). "Glargine and protamine zinc insulin have a longer duration of action and result in lower mean daily glucose concentrations than lente insulin in healthy cats." J Vet Pharmacol Ther 31(3): 205-212.
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Rios, L. and C. Ward (2008). "Feline diabetes mellitus: diagnosis, treatment, and monitoring." Compend Contin Educ Vet 30(12): 626-39; quiz 639-40.
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Diabetes in Burmese Cats

Lederer, R., J. S. Rand, et al. (2009). "Frequency of feline diabetes mellitus and breed predisposition in domestic cats in Australia." Vet J 179(2): 254-8.

Diabetes mellitus (DM) is defined as a group of metabolic disorders characterized by yperglycemia as a result of defects in insulin secretion, insulin action or both. In the United States, the reported prevalence of feline DM has increased over the past 30 years from 1 in 1250 in 1970 to 1 in 81 cats affected by the disease in 1999. A number of studies have looked at potential risk factors for the development of DM, and increasing age, being a neutered male, and being obese have been identified. In North America, no particular breed of cat appears to be associated with an increased risk for the development of DM, but this does not appear to be true in other countries. The frequency of DM in two large feline-only clinics in Brisbane, Australia over a 5-year study period is described in this report. Frequency was estimated using period prevalences (the proportion of the population at risk that was affected by diabetes at any point during a specified time period). The 5-year period prevalence of DM was 7.4 per 1000 cats. Period prevalence was significantly higher in Burmese cats (22.4 cats per 1000) than in domestic longhair or shorthair cats. There appears to be a predisposition of Burmese cats to DM in some countries, and further investigations are warranted. [SL]
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Related articles:
McCann, T. M., K. E. Simpson, et al. (2007). "Feline diabetes mellitus in the UK: the prevalence within an insured cat population and a questionnaire-based putative risk factor analysis." J Feline Med Surg 9(4): 289-99.
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Rand, J. S., L. M. Fleeman, et al. (2004). "Canine and feline diabetes mellitus: nature or nurture?" J Nutr 134(8 Suppl): 2072S-2080S.
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Oxidative Stress in Feline Diabetes

Webb, C. B. and L. Falkowski (2009). "Oxidative stress and innate immunity in feline patients with diabetes mellitus: the role of nutrition." J Feline Med Surg 11(4): 271-6.

The study was performed to test the hypothesis that oxidative stress is increased and neutrophil function is decreased in cats with diabetes mellitus (DM). Oxidative stress is considered a key component in the pathophysiology of type 2 diabetes mellitus in people. It is estimated that 85% of cats with DM are type 2 diabetics. The study included 20 control and 15 diabetic cats with measurements for oxidative stress and neutrophil function. The cats were fed a diet designed for feline diabetics (Purina DM Dietetic Management Feline Formula) for 8 weeks, and then assays were repeated. Plasma superoxide dismutase (SOD) was significantly less in cats with DM than the control cats, consistent with a greater degree of oxidative stress in the DM group. Glutathione peroxidase, an antioxidant enzyme, was increased significantly in both groups following 8 weeks of consuming a diabetes-specific diet. Other parameters of oxidative stress studied, plus neutrophil function, were similar between groups and did not change following dietary intervention. The DM cats were significantly older and heavier than the control cats and these factors could have affected differences between the two groups. The findings support continued study of antioxidant supplementation and dietary intervention in diabetic cats. [VT]
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Related articles:
Webb, C. B., K. W. McCord, et al. (2009). "Assessment of oxidative stress in leukocytes and granulocyte function following oral administration of a silibinin-phosphatidylcholine complex in cats." American Journal of Veterinary Research 70(1): 57-62.
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Webb, C. B., T. L. Lehman, et al. (2008). "Effects of an oral superoxide dismutase enzyme supplementation on indices of oxidative stress, proviral load, and CD4:CD8 ratios in asymptomatic FIV-infected cats." Journal of Feline Medicine & Surgery 10(5): 423-430.
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Diabetes in Australian Cats

Lederer, R., J. S. Rand, et al. (2009). "Frequency of feline diabetes mellitus and breed predisposition in domestic cats in Australia." Vet J 179(2): 254-8.

The prevalence of diabetes mellitus in cats seen at two large cat clinics in Brisbane, Australia over a 5 year period was evaluated. Data was analyzed by comparing diagnosis among Burmese as compared to domestic short- and long-haired cats, and between males and females. Ninety-three of 12,576 cats seen at the clinic were diagnosed with diabetes, giving a 5-year period prevalence of 7.4 per 1000 cats. Burmese cats in this population were three times more likely to be diagnosed with diabetes than other cats. In addition, males were more likely to be diagnosed with diabetes than females. Interestingly, Burmese cats were two years older on average at the time of diagnosis than the short- or long-haired cats. The underlying mechanism predisposing Burmese cats in Australia to diabetes mellitus is not known, but may be related to elevated amounts of lipids (e.g. triglycerides) in the blood, and inherited disorders of Burmese in Australia. [MK]
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Related articles:
Rand, J., L. Bobbermien, et al. (1997). "Over representation of Burmese cats with diabetes mellitus." Aust Vet J 75(6): 402-405.
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McCann, T. M., K. E. Simpson, et al. (2007). "Feline diabetes mellitus in the UK: the prevalence within an insured cat population and a questionnaire-based putative risk factor analysis." J Feline Med Surg 9(4): 289-99.
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Feline Diabetes & Dry Food Diets

Slingerland, L. I., V. V. Fazilova, et al. (2009). "Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus." Vet J 179(2): 247-253.

Researchers at Utrecht University in the Netherlands used a telephone questionnaire to investigate risk factors for development of diabetes mellitus (DM) in cats. Commercially produced dry diets are relatively high in carbohydrates especially as compared to canned food diets and the investigators hypothesized that dry food may be a risk factor for development of DM. In addition, physical activity, which is known to influence development of DM in humans, was evaluated. Owners of 96 cats diagnosed with DM from 28 clinics throughout the Netherlands were questioned. These were matched with owners of 192 healthy control cats. The association between questionnaire-derived factors and development of DM was analyzed. The researchers found that the proportion of dry food in the diet did not appear to be an independent factor for DM development, but physical inactivity and indoor confinement were. [MK]
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Related articles:
Bennett, N., D. Greco, et al. (2006). "Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus." J Fel Med Surg 8(2): 73-84.
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Martin, G. and J. Rand (1999). "Food intake and blood glucose in normal and diabetic cats fed ad libitum." J Fel Med Surg 1(4): 241.
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Diabetes & pancreatitis in cats

Forcada Y, German AJ, Noble PJ, et al. Determination of serum fPLI concentrations in cats with diabetes mellitus. J Feline Med Surg. Oct 2008;10(5):480-487.

Diabetes Mellitus (DM) is one of the primary endocrine diseases of cats. Pancreatitis is suspected of being one of the main causes for poor control of DM in cats, yet no one knows how frequently this may occur. There are no prior reports indicating the prevalence of pancreatitis in live diabetic cats. In recent years, a test determining serum feline pancreatic lipase immunoreactivity (fPLI) has been evaluated as a possible test for pancreatitis. Researchers in this study compared samples from 29 diabetic cats and 23 non-diabetic cats for measurement of fPLI concentrations to serum fructosamine levels and clinical signs. The study had three aims. The first was to determine if fPLI concentrations were higher in cats with DM. The second was to see if serum fPLI levels could be linked to diabetic control, and last, to determine if these cats had any specific clinical signs of pancreatitis.
Researchers found the median fPLI concentrations were significantly higher in the diabetic patients than the median concentrations in the non-diabetic cats. This would suggest that pancreatic inflammation is likely more prevalent in diabetic cats than non-diabetic cats. Unfortunately, a limitation of the study is that the finding of increased fPLI levels implies but does not confirm the presence of pancreatitis. Since this was a retrospective study, the investigators were unable to support a diagnosis of pancreatitis by utilization of pancreatic histopathology or abdominal ultrasonography. The median serum fructosamine values were also found to be significantly higher in the diabetic cats than the non-diabetic cats. However, there was no clear association between serum fructosamine concentrations and the clinical judgment of diabetic control by the referring veterinarian. This study indicates that pancreatitis could be a major complicating factor in a percentage of diabetic cats, even those cases that appear to be under good control based on serum fructosamine concentration. Further studies are indicated to determine how pancreatitis influences the control, progression, and management of DM and how DM and other major diseases affect fPLI concentrations.
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Related articles:
Forman MA, Marks SL, De Cock HE, et al. Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed tomography versus conventional testing for the diagnosis of feline pancreatitis. J Vet Intern Med. Nov-Dec 2004;18(6):807-815.
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Steiner JM, Wilson BG, Williams DA. Development and analytical validation of a radioimmunoassay for the measurement of feline pancreatic lipase immunoreactivity in serum. Can J Vet Res. Oct 2004;68(4):309-314.
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Remission of Diabetes in Cats

Sieber-Ruckstuhl, N. S., S. Kley, et al. (2008). "Remission of diabetes mellitus in cats with diabetic ketoacidosis." J Vet Intern Med 22(6): 1326-32.

Diabetes mellitus (DM) is one of the most common endocrine disorders in cats. DM in cats appears most similar to type 2 DM in humans, with obesity being a strong risk factor. A serious complication of DM in cats is diabetic ketoacidosis (DKA), a hyperglycemic emergency. While remission has been reported in up to 50% of cats with DM, remission in cats with severe DKA has not been reported. The purpose of this study was to evaluate medical records of cats presenting with DKA with diabetic remission and to compare them with those of cats with DKA without diabetic remission and those of cats with uncomplicated DM and diabetic remission. In this retrospective case review, the records of 12 cats with DKA and 7 cats with uncomplicated DM were analyzed. Of the cats with DKA, 7 experienced remission. These cats had more components of a stress leukogram and had pancreatic disease more often than did cats with uncomplicated DM and diabetic remission. They also had been treated more often with glucocorticoids. The researchers conclude that complete or partial remission of DM in cats presenting with DKA is possible. This finding is important as it may influence the willingness of owners and veterinarians to treat cats presenting with DKA.
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Related articles:
Zeugswetter, F. and M. Pagitz (2008). "Ketone measurements using dipstick methodology in cats with diabetes mellitus." J Small Anim Pract. [Epub ahead of print]
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Bruskiewicz, K., R. Nelson, et al. (1997). "Diabetic ketosis and ketoacidosis in cats: 42 cases (1980-1995)." J Amer Vet Med Assoc 211(2): 188-192.
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