Any CPD I’ve encountered that has been delivered by RCVS recognised feline specialist Danielle Gunn Moore has always proved invaluable and last week’s webinar covering Diabetes mellitus (DM) did not disappoint. Danielle’s extensive knowledge and hands on experience means she has the ability to offer practical tips on managing this sometimes challenging condition and any advice which makes the diagnosis and management of DM that much easier has to be a step in the right direction.
On face value the diagnosis of DM based on appropriate history, clinical signs and a persistent fasting hyperglycaemia seems straight forward enough but what if, for example, the affected cat has concurrent disease. Danielle explained that diabetic cats with concurrent hyperthyroidism may have a confusingly low fructosamine due to their high protein turnover despite having a high blood glucose. Often their thyroid level will also only be in the top third of normal as many will have sick euthyroid syndrome creating a very confusing set of blood results. Danielle did explain however that despite these odd results, often these cats will behave as typical diabetic patients with extreme polyphagia, polyuria and polydypsia.
Danielle also explained it is important to consider a number of factors and conditions in cats which could prevent successful diabetic stabilisation. These include pancreatitis, endocrinopathies such as acromegaly and cushings-like disease and finally the use of drugs such as corticosteroids, progestogens and cyclosporine. Cats suffering from these conditions may be insulin resistant which is defined as those cats which need doses of insulin greater than 2iu/kg every 12 hours. However Danielle believes we need to be investigating for the aforementioned diseases at an earlier stage when cats are on doses of insulin greater than 1iu/kg every 12 hours. She also advised that any unstable diabetic cats which are gaining rather than losing weight will, more often than not, have acromegaly and should always be investigated further.
Once a cat is diagnosed with DM, the treatment is aimed at limiting clinical signs, avoiding hypoglyceamia and aiming for diabetic remission. Danielle explained that despite figures being cited at 20-80% of cats having transient DM in reality only 50-60% of cases are likely to achieve diabetic remission. This is defined as a cat which has become normoglyceamic for at least 4 weeks. Unfortunately even in these cats there is a 25-30% relapse rate.
In order to achieve diabetic remission aggressive early treatment is necessary and usually involves administering insulin every 6-8hours alongside intensive monitoring to reduce the risk of hypoglycaemia developing. The intensity of this type of management may not be feasible for every owner and it is always important to remain realistic and flexible when considering treatment. Danielle explained it is always important to provide as much useful information as possible to owners via handouts or websites and to always try and manage their expectations about the time required for stabilisation, the possible complications and the need for home monitoring. As it happens Danielle explained that recent evidence has shown home monitoring is an area owners would like to know more about and can get frustrated by the lack of information delivered to them from their practice. The importance of diet in managing DM is another area where owners would like to hear more about from their vets.
Danielle went on to deliver a plethora of information on the diagnosis and treatment of DM as well as helping us navigate successfully through the minefield of the dreaded glucose curve interpretation. The future of diabetic patient monitoring was also discussed with the advent of continuous glucose monitoring devices such as the Freestyle Libre now being available. This device allows for continuous glucose monitoring over 14 days and is usefully callibrated in the factory. As always Danielle’s webinar delivers an excellent update on all aspects of diagnosing and treating the feline diabetic patient and should not be missed.