Keys To Management Of Diabetes In Cats - Wsava2011 - Vin
World Small Animal Veterinary Association World Congress Proceedings, 2011 Diabetes mellitus is one of the top two endocrinopathies in cats, with a prevalence estimated to be approximately 0.5% of cats seen in private practice. Successful management of diabetic cats involves insulin and dietary therapy, avoidance of corticosteroids if possible, and management of infections or concurrent diseases. As well, regular monitoring and client education are important. The goals of management are to: Enable the cat to revert to a non-insulin dependent state Minimize or eliminate clinical signs (polyuria, polydipsia, polyphagia) Improve the cat's quality of life, normalize body weight and activity Prevent complications (e.g., ketoacidosis, hypoglycemia, infections, neuropathy, etc.) Owners must be properly trained to give insulin injections and educated on the important aspects of the disease in cats. All owners need to assess how well their cat is eating, drinking and general behavior. With early intervention and good glycemic control, diabetic remission was achieved in 84100% of cats in two recent studies. The sooner glycemic control is reached, the higher the likelihood that diabetic remission can be achieved. Current recommendations support the use of a high protein (> 30% DM), low carbohydrate (< 40% DM) diet for management of feline diabetes. Several studies have demonstrated an improvement in blood glucose (BG) levels and a decreased need for insulin therapy on this type of diet. Canned food is preferred in diabetic cats to maintain hydration, lower carbohydrate content, and improve satiety. Both long-acting (e.g., glargine, determir, PZI) and intermediate-acting (e.g., porcine lente) products are available for treatment of diabetic cats (see Table 1). Most insulins are 10 Continue reading >>
How Can Prozinc Help?
PROZINC offers reliable, lasting results. PROZINC is a protamine zinc insulin -- ideal for diabetic cats -- with a convenient duration of 10-14 hours.1 It releases slowly to help maintain a consistent blood glucose level throughout the day. It's formulated just for cats. Backed by extensive clinical studies, PROZINC is specifically designed for feline diabetes and is the first protamine zinc insulin with FDA approval for diabetic cats. PROZINC makes treatment simple. Just two daily doses deliver quick and effective results regardless of the diet the cat is fed.2 Plus, PROZINC is for newly diabetic cats and cats who haven't responded well to other treatments and insulin products.2 It's proven safe for cats. It's proven safe and effective for the reduction of hyperglycemia (high blood glucose) and clinical signs associated with hyperglycemia in cats with diabetes. The safety and efficacy of PROZINC in kittens has not been evaluated.3,4 IMPORTANT SAFETY INFORMATION Owners should be advised to look for signs of hypoglycemia. PROZINC is for cats only. PROZINC Insulin, like other drugs, may cause some serious side effects. Serious side effects can occur with or without warning. Please contact your veterinarian immediately if you think your cat has a medical problem or side effect from ProZinc therapy. The most common insulin-related side effect is low blood glucose (hypoglycemia). Signs of hypoglycemia may occur suddenly and can include: weakness, depression, lethargy, sluggishness, staggering gait, behavioral changes, muscle twitching, seizures, coma, death. In a clinical study, diabetic cats showed significant improvement in fructosamine levels within just 45 days on PROZINC. The average fructosamine level dropped from 506 to 381 mol/Lby day 45 and continued to decrease ove Continue reading >>
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Diabetes We have just diagnosed your cat with diabetes. We see a lot of cats with diabetes, and with proper care and treatment, most of them do very well and have decent quality life spans. Cause and Types: ·Every time your cat eats, they ingest glucose in various amounts. To be able to metabolize this glucose, their pancreas secretes insulin, which allows the cells to be able metabolize the glucose. ·Diabetes happens when they either are not producing enough insulin, or when their cells are insulin resistant, and require higher levels of insulin to be able to metabolize the glucose. ·When glucose cannot be adequately metabolized, it starts to build up in the blood stream, resulting in various problems. This is diabetes, also known as hyperglycemia. ·There are two types of diabetes, type I and type II. oType I diabetes is caused by failure of your cat's pancreas to produce enough insulin for the body's needs. There are several factors that can affect this. §Acute or chronic pancreatitis can damage the pancreas enough so that the pancreas can no longer secrete an adequate amount of insulin. §This can also be congenital, although congenital type I diabetes is fairly rare in cats. §Idiopathic is our third cause. Idiopathic is a medical term that means we have absolutely no idea what caused it. oType II diabetes is when the cells of the body become insulin resistant, and require higher and higher levels of insulin to be able to function. §This is most commonly caused by increased levels of fat. Fat cells produce hormones that can cause insulin resistance, and the more fat cells present, the higher likelihood that insulin resistance requiring treatment will occur. ·Regardless of the type and cause, in cats they are both treated the same way. For pe Continue reading >>
Feline Diabetes Mellitus: Keys To Remission
Diabetes mellitus is a common endocrinopathy for middle age and geriatric cats. The majority of feline diabetics develop hyperglycemia due to a combination of both decreased insulin secretion from pancreatic beta cell dysfunction and insulin resistance in peripheral tissues.1 As a result, the presence of remaining beta cell function in most feline patients allows for potential remission if the disease is promptly diagnosed and effective glycemic control is achieved. As the concept of diabetic remission has become more obtainable in many patients, the focus on insulin therapy, appropriate diet, and monitoring have become a mainstay of feline diabetic management. Diabetic remission is euglycemia achieved in a diabetic patient without the need for exogenous insulin. Persistent hyperglycemia results in glucotoxicity to pancreatic beta cells, resulting in continuing dysfunction.2 If hyperglycemia is controlled with long-acting exogenous insulin administration, Beta cells may recover function in some feline patients, allowing for adequate insulin production and secretion endogenously. Clinicians should focus on insulin, diet, and monitoring to optimize the chance of diabetic remission. Insulin Twice daily administration of an insulin with a duration of effect lasting 10-14 hours in cats, such as protamine zinc insulin (Prozinc, Boehringer Ingelheim), glargine (Lantus, sanofi-aventis) or detemir (Levemir, Novo Nordisk) results in improved remission compared to intermediate acting insulin (e.g., lente insulin).3 Bennett et al found that protamine zinc insulin (PZI, Boehringer Ingelheim) treatment in combination with a low carbohydrate-low fiber diet resulted in a 68% remission rate.4 Multiple investigations of glargine on remission rates in feline diabetes have resulted in vari Continue reading >>
Insulin Products Commonly Used In Dogs And Cats
Abbreviations: BG, blood glucose; NPH, Neutral Protamine Hagedorn; PZI, protamine zinc insulin; U, units. Additional Information on Available Insulin Products: Lente (U-40 porcine insulin zinc suspension; Vetsulin, Merck Animal Health) is an intermediate-acting insulin commonly used by the Task Force in dogs. It is FDA approved for use in dogs and cats. It has a close to 12 hr duration of action in most dogs and is useful for minimizing postprandial hyperglycemia. Glargine (U-100 human recombinant; Lantus, Sanofi) is a longer-acting insulin commonly used by the Task Force in cats because it has an adequate duration of action in most diabetic cats. Several studies have demonstrated that glargine is effective for controlling blood sugar levels in diabetic cats and achieving high remission rates.12 Glargine can also be used in dogs. It is a human analog insulin with modifications that provide variable solubility at different pHs. Glargine is soluble at a pH of 4.0, the pH at which it is supplied and stored, but in the neutral pH of the body’s blood or subcutaneous tissues it forms microprecipitates, facilitating slow absorption after injection. This results in rapid onset and long duration of action. Glargine is sometimes described as a “peakless” insulin, although peakless does not mean an absence of a nadir in cats but rather refers to glucose utilization rates.4 In dogs, a flat blood glucose curve (BGC) may be seen, so glargine can be referred to as a peakless insulin in that species.13 PZI (U-40 human recombinant protamine zinc insulin; ProZinc, Boehringer Ingelheim Animal Health) is considered by clinicians as a long-acting insulin, and is FDA approved for use in cats. In field studies in cats, mean time of the BG nadir was between 5 and 7 hr and the duration of Continue reading >>
Insulin Administration In The Cat
BEGINNERS INSULIN ADMINISTRATION GUIDE FOR CATS INSULIN Insulin is the injectable medication you will be using to control your diabetic cat’s blood sugar. The goal is maintaining blood sugar levels in an acceptable range over the course of the day with once or twice a day dosing (usually twice.) Keeping the sugars in the proper range will control the excessive urination and appetite that your cat suffers from and it will require some trial and error experimentation to get the correct dose. A dose will be selected based on what research has shown to be a good starting point, and after a couple of weeks your cat will return for a glucose “curve” where blood sugar levels will be mapped out over the course of a 10-24 hour period. The curve will show if the insulin is lasting long enough and if the dose should be raised, lowered, or kept the same. Alternatively, you can learn how to monitor your cat’s blood glucose levels yourself (click here for more information) but if you are a beginner you may want to master giving the injections before moving on to actually taking blood samples. Insulin is a very simple molecule but it does differ slightly between species (i.e., cat insulin is different from dog insulin which is different from human insulin). There are presently four insulins commonly in use for cats: Vetsulin (also marketed as “Caninsulin®” in other countries), PZI insulin (presently available as Prozinc® insulin), Lantus® insulin (also called Glargine insulin), and Humulin (genetically engineered human insulin available in several formulations with different duration of action). Vetsulin is of pork origin, which is handy for dogs because canine and pork insulin are identical. Vetsulin can also be used in cats, although feline insulin is closer in struct Continue reading >>
Prozinc
This page contains information on ProZinc for veterinary use. The information provided typically includes the following: ProZinc Indications Warnings and cautions for ProZinc Direction and dosage information for ProZinc ProZinc This treatment applies to the following species: Cats Manufacturer: Boehringer Ingelheim (protamine zinc recombinant human insulin) NADA 141-297, Approved by FDA ProZinc Caution Federal law restricts this drug to use by or on the order of a licensed veterinarian. Description ProZinc® insulin is a sterile aqueous protamine zinc suspension of recombinant human insulin. Each mL contains: recombinant human insulin 40 International Units (IU) protamine sulfate 0.466 mg zinc oxide 0.088 mg glycerin 16.00 mg dibasic sodium phosphate, heptahydrate 3.78 mg phenol (added as preservative) 2.50 mg hydrochloric acid 1.63 mg water for injection (maximum) 1005 mg pH is adjusted with hydrochloric acid and/or sodium hydroxide. ProZinc Indications ProZinc (protamine zinc recombinant human insulin) is indicated for the reduction of hyperglycemia and hyperglycemia-associated clinical signs in cats with diabetes mellitus. Dosage and Administration USE OF A SYRINGE OTHER THAN A U-40 SYRINGE WILL RESULT IN INCORRECT DOSING. FOR SUBCUTANEOUS INJECTION IN CATS ONLY. DO NOT SHAKE OR AGITATE THE VIAL. ProZinc insulin should be mixed by gently rolling the vial prior to withdrawing each dose from the vial. Once mixed, ProZinc suspension has a white, cloudy appearance. Clumps or visible white particles can form in insulin suspensions: do not use the product if clumps or visible white particles persist after gently rolling the vial. Using a U-40 insulin syringe, the injection should be administered subcutaneously on the back of the neck or on the side of the cat. Always provi Continue reading >>
Feline Diabetes
Definition: Diabetes mellitus is an endocrine disease in which the blood sugar level rises because of failure of insulin to control it. This occurs either because the pancreas has lost its ability to manufacture insulin (known as Type I diabetes) or that mechanisms of insulin release and tissue responsiveness are dysfunctional (Type II diabetes). Without proper insulin regulation, the body is unable to transport glucose (a simple sugar obtained from digested food) into cells. Because glucose remains trapped in the bloodstream, the tissues of the body are deprived of the energy needed to function normally. Risk factors: In many cases, the cause for why a cat has developed diabetes cannot be determined. However, it is known that obesity predisposes cats for Type II diabetes. Other causes or factors include: damage to the pancreas caused by inflammation, infection, immune mediated disease, tumors, genetic predisposition, and exposure to certain drugs. Cats receiving steroids are also predisposed to diabetes. Symptoms: The most common symptoms of diabetes are weight loss (often with a healthy appetite), excessive water consumption and excessive urine output. Because so much urine is being produced, some diabetic cats will urinate in unusual places (i.e., outside of the litter box). Owners may notice that litter has suddenly begun to stick to their cat’s paws because of the excess volume of urine being produced. Some cats will also show weakness, lethargy, vomiting, abnormal gait, poor grooming habits and changes in behavior. Diagnosis: Physical examination may show poor body condition, dehydration, jaundice, and an enlarged liver. Laboratory testing is essential to diagnose diabetes. Blood tests show hyperglycemia (high blood sugar, usually above 300 mg/dl), and often the Continue reading >>
Diabetes
There are two forms of diabetes in cats: diabetes insipidus and diabetes mellitus. Diabetes insipidus is a very rare disorder that results in failure to regulate body water content. Your cat has the more common type of diabetes, diabetes mellitus. This disease is seen on a fairly regular basis, usually in cats 5 years of age or older. Simply put, diabetes mellitus is a failure of the pancreas to regulate blood sugar. The pancreas is a small but vital organ that is located near the stomach. It has two significant populations of cells. One group of cells produces the enzymes necessary for proper digestion. The other group, called beta cells, produces the hormone called insulin. Types of Diabetes In cats, two types of diabetes mellitus have been discovered. Both types are similar in that there is a failure to regulate blood sugar, but the basic mechanisms of disease differ somewhat between the two groups. 1. Type I, or Insulin Dependent Diabetes Mellitus, results from total or near-complete destruction of the beta cells. This is the most common type of feline diabetes. As the name implies, cats with this type of diabetes require insulin injections to stabilize blood sugar. 2. Type II, or Non-Insulin Dependent Diabetes Mellitus, is different because some insulin-producing cells remain. However, the amount produced is insufficient, there is a delayed response in secreting it, and the tissues of the cat's body are relatively resistant to it. These cats may be treated with an oral drug that stimulates the remaining functional cells to produce or release insulin in an adequate amount to normalize blood sugar. Alternatively, they may be treated with insulin. Cats with NIDDM may ultimately progress to total beta cell destruction and then require insulin injections. What Insulin d Continue reading >>
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Insulin For Cats
Most diabetic cats will require insulin therapy as part of their treatment. Diet is also an important cornerstone of treatment for feline diabetes mellitus, and a few diabetic cats can be managed with diet alone, but the majority will require insulin. There are a variety of types of insulin available. Some are designed for human use but can be useful in pets, while others have been developed specifically for animal use. The natural insulins produced by cat and dog pancreatic cells have slightly different structures than the natural insulin produced by human pancreatic cells. Insulin types made for human use match the natural human insulin, and may not always be as effective in pets. With any insulin, the goal of treatment is to safely reduce or eliminate the symptoms of diabetes (weight loss with excessive thirst, urination and appetite). There is no ‘best’ insulin for all cats, but some are preferable to others. Many veterinary internal medicine specialists recommend glargine (Lantus®, made by Sanofi Aventis) as a first-line choice. Lantus® is a recombinant human insulin which is usually very effective in cats. In combination with an appropriate diet (canned cat food with less than 7% carbohydrates), glargine has the best chance of inducing a remission, meaning that the cat will no longer require insulin. Lantus® is typically dosed at 1 or 2 units twice daily (BID). In some cats it can be used once daily. Once daily administration is not as likely to induce remission—and won’t control the blood sugar very tightly—but is an option for families or cats who can’t do twice daily injections. The glargine product information for human use recommends replacing the vial every 28 days, but if kept refrigerated, the insulin is effective for cats for at least three Continue reading >>
Prozinc (protamine Zinc Recombinant Human Insulin)
dibasic sodium phosphate, heptahydrate........ 3.78 mg phenol (added as preservative)....................... 2.50 mg hydrochloric acid............................................ 1.63 mg water for injection (maximum)....................... 1005 mg pH is adjusted with hydrochloric acid and/or sodium hydroxide. ProZinc (protamine zinc recombinant human insulin) is indicated for the reduction of hyperglycemia and hyperglycemia-associated clinical signs in cats with diabetes mellitus. USE OF A SYRINGE OTHER THAN A U-40 SYRINGE WILL RESULT IN INCORRECT DOSING. ProZinc insulin should be mixed by gently rolling the vial prior to withdrawing each dose from the vial. Once mixed, ProZinc suspension has a white, cloudy appearance. Clumps or visible white particles can form in insulin suspensions: do not use the product if clumps or visible white particles persist after gently rolling the vial. Using a U-40 insulin syringe, the injection should be administered subcutaneously on the back of the neck or on the side of the cat. Always provide the Cat Owner Information Sheet with each prescription. The initial recommended ProZinc dose is 0.1 - 0.3 IU insulin/pound of body weight (0.2 - 0.7 IU/kg) every 12 hours. The dose should be given concurrently with or right after a meal. The veterinarian should re-evaluate the cat at appropriate intervals and adjust the dose based on both clinical signs and glucose nadirs until adequate glycemic control has been attained. In the effectiveness field study, glycemic control was considered adequate if the glucose nadir from a 9-hour blood glucose curve was between 80 and 150 mg/dL and clinical signs of hyperglycemia such as polyuria, polydipsia, and weight loss were improved. Further adjustments in the dosage may be necessary with changes in the ca Continue reading >>
Cat Insulin
Cat insulin is a frustrating topic. Cat diabetes has practically become an epidemic in the U.S. for many of the same reasons adult onset diabetes in people has risen dramatically - obesity and, in the case of cats, a diet that is too rich in carbohydrates. However, unlike human diabetes who have many different types of insulin to chose from, the selection of insulin for cats has a history of being mainly unsatisfactory. That's because most insulin is made for people and when insulin is made specifically for animals, it has traditionally been directed at dogs. When it comes to insulin, a cat's own natural insulin is most like beef insulin. Cats have also been successfully treated using beef-pork insulin because it is 10 percent pork and 90 percent beef. Unfortunately, I have seen such types of insulin that are most appropriate for cats come and go over the last 20 years. Just as a patient would get well-regulated on one type of insulin, it would be discontinued and we would have to start a different type. It has been a frustrating situation. That's not to say that you cannot treat your diabetic cat successfully with insulin. Currently, due to a lack of animal-source insulins, most cats are started on human recombinant insulin. Even in the field of human insulin where there have been dozens of different insulins available, so many have been discontinued - it's enough to make your head spin. At the moment, there is an insulin developed just for cats. It's called PROZINC. Will it still be around a year from now? Who knows. Is it the best insulin? No. Does it work well in all cats? No. For that reason, your veterinarian will discuss with you the available types of insulin if your cat is diagnosed with diabetes and he will, no doubt, have his own preference. ProZinc stands fo Continue reading >>
Feline Insulin Solutions: A Roundtable Discussion (sponsored By Boehringer Ingelheim Vetmedica, Inc.)
Previous 1234567891011Next Dr. Scott-Moncrieff: For cats being treated with glargine, the blood glucose concentration can be in the well-controlled range right before the next injection and that may not be a problem. It could be in the 80- to 120-mg/dl range right before the next injection and that could just reflect good control. Whereas with other insulins, the blood glucose concentration tends to be the highest right before you give the next dose. Dr. Norsworthy: If you are starting with a newly diagnosed diabetic cat, do you consider how high the blood glucose concentration is when choosing an insulin dose? Dr. Nelson: No, I start with one unit of PZI twice a day and go from there. I am trying to avoid having symptomatic hypoglycemia occur at home in the first week or two. The owner is dealing with handling the syringes, drawing up the insulin, understanding the treatment protocol, and more. The last thing I want is the animal to become hypoglycemic. So I always start conservatively. If I feel the diabetes is not controlled, I will adjust the dose within a week, usually at five to seven days. If the owner is reporting improvement and the cat is eating a high-protein, low-carbohydrate diet, then I will let it go a little longer. I tell most of my clients that it will take about a month, whether their cats are newly diagnosed or we're trying to regain control. Dr. Peterson: I think we are all saying one to two units of PZI twice a day and then we check them in the first week and make adjustments. We've agreed for 20 years that once a day is not going to do it. Dr. Ford: If you were going to change a cat from glargine to PZI, where would you start? Dr. Nelson: I usually start at one unit per cat twice a day. Dr. Scott-Moncrieff: In the original PZI study, there was no Continue reading >>
Specific Insulin Info & Dosing Scales
There are many kinds of insulin available to use for our FD cats. Some perform much better than others and each has its idiosyncrasies. Sometimes we will have a choice when it comes to which insulin is prescribed by our vets; sometimes we won't. Whatever insulin, all insulin types have been proven to work with TR. The insulin types addressed in this sticky are PZI (compounded, ProZinc and Hypurin), Lantus, Levemir, NPH (Humulin N), Caninsulin/Vetsulin, please scroll down to for information on the specific insulin. It is advised to start TR / Insulin when you are available to monitor your cat’s BG frequently by performing frequent testing and/or curves for the first few days until you know how your cat processes their insulin. One of the important premises TR is built on is maintaining overlap between doses – meaning that the remnants of the prior shot are still working to keep the BG from rising very high, while the next shot approaches onset (when the insulin starts to work). Different insulin types have different durations -experienced members on forum will help guide you through the process of understanding the nuances of the insulin you are using to get maximum results. Insulin should be stored in the fridge at all times, in a protected spot on a less-used shelf, in a sturdy, padded container where it will not get knocked over. Do not store insulin on the door of your fridge to avoid excess jostling. Practicing TR we handle our insulin more often than when dosing twice a day. Handling your insulin gently and with care will prolong potency considerably. Dr. Hodgkins' Tight Regulation protocol was developed for use with bovine based PZI insulin but it has been proven over time that many insulin types work very well with TR. Please scroll down this page for explana Continue reading >>
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What's The Best Insulin For Diabetic Cats And Dogs?
With the reintroduction of Vetsulin (porcine insulin zinc suspension) to the U.S. market (1-3), I've received a number of questions concerning the use of this insulin in dogs and cats. Here are the major questions I've received: Is this the initial insulin of choice for dogs? How about for cats? Should this be an insulin that we turn to for our newly diagnosed feline diabetics? If we have a dog or cat that isn't responding well to the current insulin, should they be switched to Vetsulin? How will this insulin compare to NPH, glargine (Lantus), detemir (Levemir), or PZI (ProZinc) in cats or dogs? How does the cost compare to these other insulin preparations? Is this the initial insulin of choice for dogs? In my opinion, the answer to that is yes, this is the initial insulin of choice for most dogs. Because it's composed of both short and long-acting insulin components, Vetsulin helps control postprandial hyperglycemia and has a longer duration of action than NPH in most dogs (4-7). The cost is approximately the same as NPH, but less than the insulin analogues (e.g., detemir and glargine). See more below, where I do my cost-comparisons for the various insulin preparations. Is this the initial insulin of choice for cats? A number of studies have proven that Vetsulin will certainly control hyperglycemia in cats, especially if combined with a low carbohydrate diet (<10% of calories) (8-11). However, the duration of action may be too short in some diabetic cats, and most feel that the longer acting insulin preparations (glargine, detemir or ProZinc) work better to maintain better control of hyperglycemia in cats (11-13). Of course, maintaining glycemic control throughout the day is more important if diabetic remission is the goal (13,15,16)— if not, Vetsulin might be less e Continue reading >>
