ACCREDITED CPD
tient’s progress. What exactly is recorded can be altered to suit each individual.
Date
Date
Date
Insulin am – time and amount
Insulin pm – time and amount
Food - amount
Appetite
Water intake in ml
Body weight, condition score
gain decreases insulin sensitivity by 30% in cats!). This
means you MUST monitor diabetic cats closely. Your
clients may find this tedious but:
* if you get your treatment right, you may be able to
wean the cat off insulin completely
* if you don’t continue monitoring and the glucose
toxicity resolves, the cat will have episodes of hyopglycaemia If you’re lucky, signs will be mild (a bit
of a wobble), but if you’re not, you could have severe neurological symptoms developing: seizures,
brain oedema and resultant blindness (thankfully
often temporary).
Habitus
Urine (accidents indoors, how often
waking owner at night)
Exercise
Hypos / other observations
Feeding:
Dogs should be fed the same amount ot the same
food at the same time every day
• exactly the same amount of food for each insulin
injection to “work on”. While you’re stabilising him
he will probably need to eat more than the weight
guide of the food suggests. That’s OK. You don’t
want a skeleton, so feed more. But agree on the
amount with the client and keep it the same every
day till you both decide to change that amount)
• exactly the same food. I don’t insist on a prescription diet for dogs unless they have concurrent
problems or are proving difficult to stabilise, but
do avoid tinned foods with simple carbohydrates.
• at the same time every day. Feed twice a day in
dogs, at same times as insulin injections - as close
to 12 hrs apart as practical/possible for the owners
• NO TREATS while stabilising. You know your client... if this is impossible, the treats need to be incorporated into the daily allowance and kept the
same every day.
Possible responses to insulin overdose:
• Somogyi overswing (figure 1) - the high insulin dose
causes the glucose to drop below 3.3 mmol/l.
This stimulates the release of counter regulatory
hormones including glucagon, adrenalin, cortisol
- which cause a rapid increase in blood glucose.
This yoyo effect happens quickly and is one reason why glucose readings should be taken at least
every 2 hrs during a curve. If I have a patient in
hospital whose glucose readings are approaching
3 mmol/l I will often take more frequent readings
for 2 reasons: so as not to miss a hypoglycaemic
episode that needs treatment and also not to miss
a Somogyi overswing. Animals that have had a
Somogyi overswing may have persistently and uncharacteristically high glucose levels for 2-3 DAYS
after the glucose dip. If you happen to do your
glucose curve during this time, the patient will
often appear insulin resistant. This illustrates why
it important to take a good history and why you
should never make a decision about changing a
patient’s insulin dose based on one test alone –
not even if that test is a glucose curve.
• The patient adapts to low glucose (rather like an
insulinoma dog). This becomes more likely the
more frequently the patient is hypoglycaemic.
Cats won’t usually eat at prescribed times. I agree on a
daily amount of food in grams with the client and ask
them to stick to that. It’s important that the cat eats
approximately the same amount of food after each
insulin injection. If your patient eats 100g of food after the morning insulin injection and only 30g after
the evening one, you cannot expect to stabilise the
cat unless you also vary your insulin dose. This is tedious (because there’s a good chance someone is going to need to check blood glucoses in the middle of
the night) and it takes a lot longer to stabilise the cat.
Feeding a prescription high protein low carbohydrate
diet shows significant benefits in diabetic cats.
Glucose toxicity in cats: Chronic hyperglycaemia is
toxic to beta cells and decreases insulin release. The
pathogenesis is not clear. Once it resolves and endogenous insulin secretion increases, exogenous insulin
requirements may fall drastically or even disappear. Insulin resistance may also improve dramatically as the
cat loses weight (studies have shown that a 1kg weight
Figure 1: Somogyi overswing: An insulin dose which is too
high will cause the nadir to drop very low which may stimulate counter-regulatory hormones which act to rapidly increase
blood glucose again. This results in a high blood glucose reading at the end of the 12 or 24 hour period and may lead one to
think the dose is actually too low. It is thus vital to sample every
two hours at least when performing a glucose curve so that you
don't miss the nadir.
Issue 04 | JULY 2015 | 17