Feline Diabetes Mellitus A look at insulin stabilizati on and home monitoring, as well as long term management and complications. by Dr Lea Stogdale, DVM, Diplomate ACVIM Small Animals
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n Part 1 of this article (IVC, Winter 2012), I covered the diagnosis of feline diabetes mellitus, and how early DM can be managed with diet, medication and herbs. Now I’ll discuss insulin stabilization and home monitoring, the complications that can occur with the disease, and the reasons why some cats don’t recover.
Insulin requirements Feline DM is treated with Rx insulin injections twice a day (BID) combined with home BG monitoring. Cats metabolize insulin twice as fast as dogs or humans, and ideally, a cat with DM should be eating a very low carbohydrate diet twice a day. Hence the ultra-long-acting human insulins, Glargine “Lantus” or Detemir “Levemir”, work best for these cats. • Rx Glargine = “Lantus”: This acid pH insulin precipitates in the neutral pH of the body and is absorbed slowly. The initial dose is 1 to 2 IU/cat twice a day. It lasts 12 to 18 hours. The bottles are
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10 ml and fairly expensive. • Rx Detemir = “Levemir”: The Detemir insulin is strongly protein bound (that is, albumin bound) and slowly released. The initial dose is 1 to 2 IU/ cat twice a day. It lasts 18 to 21 hours. One box contains 5 x 3 ml vials. Detemir appears to be better tolerated than “Levemir” in some cats, and may have less variability. As Detemir is strongly protein bound, there is the potential for drug interactions. Other drugs commonly used in cats that are also strongly protein bound include the injectable longacting penicillins, long-acting cephalexin, and Rx Propofol, an injectable anesthetic. I now prefer “Levemir” insulin in my diabetic cats. I find the BG nadir occurs, on average, about three to six hours after injection, and there is a fairly flat BG curve. On “Lantus” and “Levemir”, over 80% of my newly diagnosed diabetic cats recover within three months. I purchase the box of “Levemir” and dispense the 3 ml vials to owners.
