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Feline Diabetes Remission Signs

Cvc Highlight: What Influences Diabetic Remission In Cats

Cvc Highlight: What Influences Diabetic Remission In Cats

A look at which factors might make spontaneous normalization of glycemic control more likely in one of your feline patients. A unique feature of diabetes mellitus in cats is that some cats become non-insulin-dependent after treatment has been initiated. From 17% to 67% of cats with diabetes mellitus have been reported to go into spontaneous clinical remission after insulin treatment is initiated.1-4 Diabetic remission is usually defined as normoglycemia that persists for more than four weeks without the use of exogenous insulin,2 although some studies have defined it as euglycemia for only two weeks.5,6 The duration of remission varies, with some cats requiring insulin treatment again within a few weeks to months and other cats remaining in remission for months to years. Factors that have been hypothesized to influence the likelihood of diabetic remission include the duration of diabetes mellitus, whether the cat initially presented in a ketoacidotic crisis, the carbohydrate content of the diet, the type of insulin used for treatment, the cat’s breed, the presence of underlying disease, and how closely the blood glucose concentration is maintained within the normal range with insulin treatment. Stimulation tests with secretagogues such as glucagon and arginine have also been investigated to identify cats that have residual insulin secretion from the pancreas, but the presence of glucose toxicosis in cats complicates the interpretation of these tests, and they have not proved useful in predicting the likelihood of remission.7,8 In a study of factors influencing diabetic remission in cats, remission was found to be more likely with increasing age and increasing cholesterol concentration.2 Overall, 21 cats treated with insulin glargine and 23 cats treated with Lente insu Continue reading >>

About Glucose Curves

About Glucose Curves

Go to site For Pet Owners The glucose curve is a great tool to differentiate between an insufficient insulin dose and the Somogyi effect. It helps to determine insulin effectiveness and the maximum and minimum levels of glycemia, which ideally should be between 120–300 mg/dL (5.6–16.7mmol/L) for cats for most of the day.8 Try our online glucose curve generator. Veterinarians commonly adjust the insulin dose based on a blood glucose curve. When creating a glucose curve, remember that stress can affect the reliability of results, and the glucose curve is only one tool among others that can help diagnose and monitor diabetes mellitus. Take clinical signs (or lack thereof) into account when contemplating any change in the insulin therapy. The ultimate goal in regulating the diabetic cat is to control the clinical signs adequately so that the patient enjoys a good quality of life. How to complete a glucose curve The procedure is as follows: shortly after the animal has been given its first meal (preferably at home), the first blood sample is taken just prior to the insulin injection in the morning. Thereafter, blood samples are collected every 2 hours throughout the day for 12 hours, if possible. These data are then plotted on a graph to generate a curve. Veterinarians can determine based on the nadir whether the dose needs to be increased or decreased (or remain as is). How to interpret a glucose curve The aim of treatment is to alleviate clinical signs of diabetes. To achieve this goal, keep blood glucose concentrations below the renal threshold and avoid hypoglycemia. Thus, the goal is to maintain blood glucose concentrations roughly between 120 to 300 mg/dL in cats for the majority of the day.8 The duration of insulin action is measured from the time of Vetsulin® (p Continue reading >>

Review Systematic Review Of Feline Diabetic Remission: Separating Fact From Opinion

Review Systematic Review Of Feline Diabetic Remission: Separating Fact From Opinion

Highlights • A systematic review identified factors influencing feline diabetic remission. • Identified articles were associated with a low to medium level of evidence. • No single factor successfully identifies which cats will achieve remission. • Remission can occur with a variety of treatment protocols. • Well-designed trials are needed to compare remission rates with different insulins. Abstract It is increasingly recognised that diabetic remission is possible in the cat. This systematic review, following Cochrane Collaboration (CC) guidelines, critically appraises the level of evidence on factors influencing remission rate and factors predicting remission. A systematic online, bibliographic search and reference list examination was conducted. A level of evidence was assigned to each identified article by five internists using the Newcastle–Ottawa Scale for follow-up, cohort, case-series and case-control studies, the CC's risk of bias tool for trials and the Cochrane Effective Practice and Organisation of Care Group risk of bias criteria for before and after trials. Twenty-two studies were included in the review, assessing influence of pharmaceutical intervention (n = 14) and diet (n = 4), as well as diagnostic tests (n = 9) and feline patient characteristics (n = 5) as predictors of remission. The current level of evidence was found to be moderate to poor. Common sources of bias included lack of randomisation and blinding among trials, and many studies were affected by small sample size. Failure to provide criteria for the diagnosis of diabetes, or diabetic remission, and poor control of confounding factors were frequent causes of poor study design. Addressing these factors would significantly strengthen future research and ultimately allow meta-analyse Continue reading >>

Signs Of Cat Diabetes Remission

Signs Of Cat Diabetes Remission

Cat diabetes is an incurable disease, but in some cases, periods of remission are possible. However, for remission, the cat needs to have a change in diet, possibly lose some weight and get regular insulin treatment. The signs of cat diabetes remission may be difficult to detect, as these are often subtle or don’t appear. Testing the glycemic index is a safe way to detect if the cat is in remission. Cat Diabetes Remission Cat diabetes may be of 4 types. If the cat is affected by type 1 diabetes, the chances of remission are very low, as the cat may require insulin for life. If the cat has type 2 diabetes (often caused by obesity, a diet that is high in carbohydrates and a sedentary lifestyle), remission is possible and highly likely. However, in order to get to a remission phase, the cat needs to: Get regular insulin shots, with the doses required by the body to assimilate the glucose in the blood Have a change in the cat’s diet, reducing the amount of carbohydrates and increasing the proteins and fibers Lose weight, as obesity may have caused the diabetes in the first place Get plenty of exercise Type 3 diabetes is caused by an underlying condition such as pancreatitis or a hormonal disorder in the cat’s body. Total remission is possible in this case, provided that the underlying condition is properly treated. Type 4 diabetes is inherited and the cat has the disease from the day he is born. In this case, the cat won’t be able to have a remission phase and he will have to get insulin shots for life. Cat Diabetes Remission Symptoms Remission is possible if the cat has type 2 and 3 diabetes. The symptoms of remission are often too subtle to be recognized. However, you may notice some signs such as: Increased thirst Sleepiness and lack of energy alternating with no Continue reading >>

Many Cats With Diabetes Can Achieve Remission

Many Cats With Diabetes Can Achieve Remission

If your cat seems to be thirstier than usual, is urinating frequently, is hungry all the time but also losing weight, you should have him checked by your veterinarian for feline diabetes. Other signs to watch for include urinating outside the litter box, sweet-smelling breath, lethargy, dehydration, poor coat condition, and urinary tract infections. Left untreated, diabetes can cause your kitty to lose his appetite and a significant amount of weight, and develop muscle weakness. Uncontrolled, the disease can ultimately result in diabetic neuropathy, a condition in which there is profound rear limb weakness and a plantigrade walk, meaning the ankles are actually on the ground as the cat walks. Feline Diabetes Mellitus Diabetes mellitus is a common disease in older cats, and is especially prevalent in kitties fed dry food diets. In fact, a study published in the Journal of Feline Medicine and Surgery concluded that high-protein, low-carb diets are as or more effective than insulin at causing remission of diabetes in cats. The pancreas produces insulin based on the level of glucose in the blood. Insulin is necessary in order for glucose to enter the cells of the body. When glucose levels are high (which normally occurs after a meal), insulin is released. When there is not enough insulin being released from the pancreas, or there is an abnormal release of insulin coupled with an inadequate response of the body’s cells to the insulin, diabetes mellitus is the result. Sugar in the bloodstream cannot get into the cells of the body, so the body starts breaking down fat and protein stores to use as energy. As a result, no matter how much the cat eats, she loses weight. In addition, the glucose builds up in the bloodstream and is eliminated through urination. This leads to exce Continue reading >>

Clinical Remission Of Diabetes Mellitus In Cats

Clinical Remission Of Diabetes Mellitus In Cats

In cats treatment of diabetes mellitus may result in clinical remission in 25% of cases. Diabetic cats that go into diabetic clinical remission have remaining functional beta cells in the pancreatic islets which are able to produce sufficient insulin once persistent hyperglycaemia, which results in glucose toxicity, is treated adequately with insulin. The time to remission is variable and likely depends on how long the hyperglycaemia, and glucose toxicity, has been present and if there are remaining functional beta cells in the pancreatic islets. In diabetic cats it may be shortly after the start of treatment (e.g. around 2 weeks) in cats that have not been diabetic for long or take up to 3-4 months or longer after starting treatment in cats that have been diabetic for longer. Although many diabetic cats that go into clinical remission seem to remain in remission it is important to remember that remission does not necessarily mean cure. Care with diet and exercise and avoidance of aggravating factors (progesterone, progestogens, corticosteroids, obesity, etc.) are important. Continue reading >>

Glycemic Status And Predictors Of Relapse For Diabetic Cats In Remission

Glycemic Status And Predictors Of Relapse For Diabetic Cats In Remission

Go to: Abstract It is unknown if diabetic cats in remission have persistent abnormalities of glucose metabolism and should be considered prediabetic, or have normal glucose tolerance. Objective To characterize glycemic status of diabetic cats in remission and to determine predictors of relapse. At a median of 107 days after remission, screening blood glucose concentration was measured on entry to the clinic. After a 24‐hour fast in hospital, fasting blood glucose, fructosamine and feline pancreatic lipase concentrations were measured, and 3 hours later, a simplified IV glucose tolerance test (1 g glucose/kg) performed. Twenty cats were monitored for relapse for at least 9 months. Of the 21 cats in remission, 19% (4/21) had impaired fasting glucose concentration and 76% (16/21) had impaired glucose tolerance. Of cats followed up for 9 months after testing, 30% (6/20) had relapsed and required insulin treatment. Fasting blood glucose concentration ≥7.5 mmol/L (≥135 mg/dL) (odds ratio [OR] = 12.8) and severely impaired glucose tolerance (≥5 hours to return to <6.5 mmol/L or <117 mg/dL; OR = 15.2) were significantly associated with relapse. Blood glucose concentration >14 mmol/L; 252 mg/dL at 3 hours was significantly associated with relapse (OR = 10.1). Most cats in diabetic remission have impaired glucose tolerance and a minority have impaired fasting glucose concentration and should be considered prediabetic. More severe glucose intolerance and impaired fasting glucose concentration are predictors of relapse. Ongoing glucose monitoring of diabetic cats in remission is recommended. Keywords: Diabetes mellitus, Glucose tolerance test, Impaired fasting glucose concentration, Impaired glucose tolerance, Prediabetic, Screening glucose Continue reading >>

Diabetes Mellitus In Cats

Diabetes Mellitus In Cats

What is diabetes mellitus? Diabetes mellitus is a disease caused by failure of the pancreas to produce adequate amounts of insulin or of the body to respond to the insulin that is produced. Why is insulin so important? The role of insulin is much like that of a gatekeeper: It stands at the surface of body cells and opens the door, allowing glucose to leave the blood stream and pass inside the cells. Glucose, or blood sugar, is a vital substance that provides much of the energy needed for life and it must work inside the cells. Without an adequate amount of insulin, glucose is unable to get into the cells. It accumulates in the blood, setting in motion a series of events which can ultimately prove fatal. When insulin is deficient, the cells become starved for a source of energy. In response to this, the body starts breaking down stores of fat and protein to use as alternative energy sources. This causes the cat to eat more, but ultimately results in weight loss. The body tries to eliminate the excess glucose by excreting it in the urine. However, glucose attracts water, so the urine glucose that is excreted also contains large quantities of the body's fluids. This causes the cat to produce a large amount of urine. To avoid dehydration, the cat drinks more and more water. Not all of these signs are readily seen in every diabetic cat, but we expect that you will have seen at least two of them. How is diabetes mellitus diagnosed? Because the four classical signs of diabetes are also present in other feline diseases, clinical signs alone are not sufficient to make a diagnosis. We also look for a high level of glucose in the blood stream and the presence of glucose in the urine using laboratory tests. The normal blood glucose level for cats is 80 to 120 mg/dL, while diabetic Continue reading >>

How To Keep A Cat In Diabetic Remission

How To Keep A Cat In Diabetic Remission

Expert Reviewed If your cat suffers from feline diabetes, it is still possible for your kitty to return to an insulin-free life with the proper treatment. After your cat receives a diabetes diagnosis from your veterinarian, you must start treating the condition immediately. With the right insulin doses and a healthy diet, your cat may enter diabetic remission. To keep your cat in remission, you should help your cat stay healthy and fit through proper diet and exercise. You also need to always be wary of returning symptoms of feline diabetes. 1 Consult your veterinarian. Feline diabetes is a serious condition that must be treated with the supervision of a medical professional. You need to get a diagnosis from your vet and advice on a recommended plan for treatment.[1] If you think your cat has diabetes, or if your cat’s existing diabetes has changed, you need to schedule an appointment to see the veterinarian. 2 Prepare an insulin injection. Insert the end of the sterilized syringe into the vial of insulin and pull back on the dropper until you reach the proper dosage. You should push the plunger all the way down to release the insulin back into the vial, and redraw the insulin again. This will help you safely get the right dosage, as insulin can stick to the inside of the plastic syringe or create an air bubble inside.[2] Don’t shake the insulin bottle unless directed to do so by your vet. 3 Administer insulin to your cat. This is usually given to cats by injection twice daily, but sometimes can be administered differently depending on the formulation. Follow your vet’s advice on how to give your cat the insulin. Typically, insulin shots are given in the back, in the skin between the cat’s shoulder blades.[3] Pull on this loose skin so that it pulls up and away Continue reading >>

Feline Diabetes Mellitus Updates On Diagnosis & Treatment

Feline Diabetes Mellitus Updates On Diagnosis & Treatment

David Bruyette, DVM, Diplomate ACVIM, and Karen Eiler, DVM, MS, Diplomate ACVIM Feline diabetes mellitus, one of the most commonly encountered feline endocrine diseases, is comprehensively reviewed, with an emphasis on providing up-to-date information on diagnosis and treatment based on current literature and research. The article outlines the insulins available for therapeutic use in cats and the nuances of each; a table provides insulin doses. Pathogenesis, diagnostics, other management modalities, and monitoring are also addressed. Diabetes mellitus (DM) is a commonly encountered feline endocrine disease.1 DM is defined as persistent hyperglycemia and glycosuria due to an absolute or relative insulin deficiency. The most common causes of feline DM are: Islet cell amyloidosis Obesity Chronic pancreatitis. CLASSIFICATION Insulin is secreted exclusively from beta cells in the pancreas’ Islets of Langerhans. Insulin deficiency occurs when beta cells are destroyed or their function impaired, and the pathogenesis of beta cell dysfunction is used to classify DM. In humans, DM is classified as: Type I (insulin dependent): Results from autoimmune damage to the Islets; associated with complete lack of insulin Type II (noninsulin dependent): Characterized by abnormal insulin secretion and peripheral insulin resistance Gestational, congenital, neonatal, or monogenic. Most feline diabetics have type II DM,2 and may have underlying susceptibilities to this type due to genetic predisposition and decreased insulin sensitivity (seen with obesity).3,4 Type III DM is similar to impaired glucose tolerance in humans. Medications or diabetogenic hormones (epinephrine, cortisol, glucagon, and growth hormone) interfere with the action of insulin, result in glucose intolerance, and ultimat Continue reading >>

Diabetic Remission In Cats

Diabetic Remission In Cats

To grasp diabetic remission in cats, it helps to have an understanding of feline diabetes, so here is a quick review. Diabetes is a complex disease involving a hormone called insulin. When a cat does not make enough insulin or cannot properly use the insulin it does make, diabetes results. Why is insulin important? Insulin keeps the body’s engine working properly. The body is like a well-tuned machine and needs fuel to run properly. The fuel for a cat is food that contains fats, carbohydrates, and proteins. But this fuel needs to be broken down into smaller parts that the body can utilize. One of these usable fuel components is glucose. Without glucose, the body’s engine stalls. Glucose must enter the body’s individual cells to keep the engine running. That is where insulin comes in to play. Insulin regulates the flow of glucose from the blood stream into the cells where it is needed to sustain life. When there is not enough insulin produced by the pancreas, or the cat does not use it effectively, glucose cannot enter the cells and high levels of glucose build up in the bloodstream. This condition is called diabetes. "The common signs of diabetes include increases in appetite, water consumption, and urination, along with weight loss." Without insulin to steer glucose into the cells, the cat's body looks for alternative sources of fuel and breaks down reserves of fat and protein stored in the body. Fueling the body is not efficient without the insulin/glucose team, so the cat loses weight despite eating more. Meanwhile, the accumulation of glucose in the blood stream is eliminated in the urine. The cat urinates more which makes him thirsty and he drinks more water. The common signs of diabetes include increases in appetite, water consumption, and urination, along w Continue reading >>

Feline Diabetes: Five Principles Breed Success

Feline Diabetes: Five Principles Breed Success

Feline Diabetes: Five Principles Breed Success Five principles to help any owner help manage feline diabetes in their cat. Diabetic cats and the challenges associated with their management intrigue me, which is why I have about 75 diabetic patients in my practice at any given time. Successful management of a diabetic cat requires a multifaceted approach that begins with five principles: Tight control is not essential and probably not even desirable. Cats tolerate hyperglycemia without significant consequences better than humans or dogs do. Hyperglycemia is always better than hypoglycemia. The latter can be fatal. As long as the cat is not ketoacidotic, it is not critically ill. You do not have to get the cat regulated in the first week, or even in the first month, after diagnosis. Consistency is extremely important in maintaining regulation. The more things you can keep the samediet, exercise, stressthe easier it is to regulate the diabetic cat. Monitoring clinical signs is vital in achieving and maintaining regulation. With few exceptions, if the clinical signs and the blood-glucose level conflict, believe the clinical signs. Based on these five principles, here are four treatment steps: Client education. You are the coach on the sidelines. Your job is to instruct the quarterback so the plays are run properly. I recommend a client information handout that details the treatment plan. Treat other diseases. The most commonly associated diseases are chronic pancreatitis (50 percent incidence in newly diagnosed diabetic cats) and periodontal disease. After the diagnosis of diabetes is made, I recommend a urine culture and feline PLI1 as minimum diagnostics after the MDB (CBC, chemistry profile with electrolytes, FeLV/FIV test, urinalysis). I usually put my newly diagnosed Continue reading >>

Diabetic Remission

Diabetic Remission

How to recognise and approach diabetic remission Good glycemic control soon after diagnosis reverses glucose toxicity and many newly-diagnosed diabetic cats can have their insulin dose gradually reduced and many can have their insulin completely withdrawn. It is suggested that insulin not be withdrawn completely for at least two weeks after starting insulin therapy to ensure adequate time for beta cells to recover from glucose toxicity. Insulin dose can be reduced when indicated by low blood glucose parameters listed above. If pre-insulin glucose is below 10mmol/L and insulin dose has been reduced to 1U, insulin should be withheld and blood glucose measured for 12hrs (if the pre-insulin glucose is below 10mmol/L and insulin dose greater than 1U, insulin dose should be reduced to 1U rather than withheld and pre-insulin glucose measured again in 3-7 days). In most cases, if when insulin is withheld the blood glucose concentration rises rapidly or significantly over 10mmol/L cats should be discharged on 1U twice daily rises slowly towards or just above 10mmol/L, then cats should be discharged on 1U once daily remains below 10mmol/L for 12hrs with no insulin, they can be assumed to be non-insulin dependant and cats should be discharged without insulin with their blood glucose monitored every 2-3 days for several weeks. Confirmed non-insulin dependant diabetic cats should have their blood glucose checked weekly for 3 months and then monthly forever. Some cats may have a pre-insulin glucose concentration below 10mmol/L within 2 weeks, but insulin therapy should be maintained for at least 2 weeks to give beta cells adequate time to recover from glucose toxicity. Use 1U BID or SID until insulin is withdrawn. What to do with a diabetic cat in remission Once remission has occurre Continue reading >>

What To Expect When Your Cat Goes Into Diabetic Remission

What To Expect When Your Cat Goes Into Diabetic Remission

This week I received an email from one of our readers asking what to expect as her cat seems to be going into diabetic remission. So I got out my crystal ball and… Wait! I don’t have a crystal ball. How it plays out varies from pet to pet. I suppose what I can share with you is what I have seen over the years with some of my feline patients who have gone into remission. And I can offer some pointers to help keep the kitty in remission. Cats are usually type 2 diabetics, meaning they may yet produce insulin but don’t react to it as well as they should. This is called insulin resistance. Factors that commonly cause insulin resistance include obesity, high carbohydrate diets (such as cat kibble), infections (such as dental disease) and lack of exercise (rampant with indoor kitties). If we address these issues and provide them with supplemental insulin, a good portion of cats can go back into a non-diabetic state. This is called remission. How amazing is it that we can turn the situation around and actually “cure” these cats! Now, how this plays out varies. If you are very attuned to your diabetic feline and monitor the blood glucose at home, you will have a better outcome. As much as we hope for diabetic remission, if we fail to notice signs of diabetic resolution, the typical dose of insulin that had been working just fine for months might result in hypoglycemia. Mild hypoglycemia may not be noticed. Moderate hypoglycemia may look like a drunken cat. If the blood glucose gets below 20 or 30 mg/dl, the pet could seizure. If no one is home, this could be life threatening. To avoid tragic events like this one, I want all my clients with a diabetic to have a glucose meter at home. I keep close contact with them. If the pet is acting odd or goofy in any way, I have t Continue reading >>

Can Feline Diabetes Be Cured?

Can Feline Diabetes Be Cured?

For some cats with diabetes, cure of the disease or remission of the disease for a period of time is possible. Is It Possible to Experience a Cure or Remission? Cats that are diagnosed early in the course of disease while the disease is still mild are more likely to be cured or to undergo remission than those that have been struggling with diabetes for some time without treatment. In a normal cat, the pancreas is responsible for secreting insulin in response to rising blood glucose (blood sugar) levels. The insulin then acts to decrease the blood glucose levels and keep them within an appropriate range. In a diabetic cat, for whatever reason, the body is not able to adequately utilize the insulin produced to decrease the blood glucose to an acceptable range. However, the pancreas still retains the ability, at least to some degree, to secrete insulin. In this situation, if the blood glucose levels can be kept within a proper range with veterinary medical treatment, the cat's body might then have a chance to recover and the pancreas can resume its task of secreting insulin to regulate the blood glucose. Why Can Some Cats with Diabetes Be Cured and Others Not? If the cat has suffered from diabetes long enough that the pancreas has been irreparably damaged and the pancreatic cells that secrete insulin have been "burned out", the cat will be beyond cure and will need to be treated for diabetes for the rest of his life. However, if the diagnosis can be made early enough in the course of the disease that the pancreas is not irreparably damaged, then cure is possible. The best thing that you can do is to have your cat examined by your veterinarian on a regular basis. Your veterinarian can perform routine blood and urine testing to ensure that your cat is healthy or detect early Continue reading >>

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