Diabetes mellitus affects not only humans; this disease is also diagnosed in cats. You can find out if your pet has this disease from a veterinarian. The symptoms and treatment of diabetes in cats are often different from those in humans, so owners should not try to diagnose it themselves. With adequate therapy, complete freedom from the disease is possible.
Types of diabetes in cats
There are 2 types of diabetes in humans, but in cats there are 3, just like in dogs. The following types of disease are distinguished::
- insulin dependent;
- acquired after an illness;
- not dependent on insulin-containing drugs.
With the second and third types of diabetes mellitus in cats, a complete cure is possible. However, this will require full compliance with the doctor's instructions and a strict veterinary diet.
Insulin dependent
This type of diabetes mellitus in cats develops due to autoimmune damage to the pancreas. As a result, the diseased organ is no longer able to produce insulin. Often, such diabetes in cats can be accompanied by other autoimmune problems. The insulin-dependent type cannot be cured, but fortunately it is quite rare in animals.
Insulin independent
In the independent type of diabetes mellitus in cats, insulin is produced by the pancreas, but the tissues are not sensitive to it. This form of the disease is most widespread and accounts for almost 90% of cases. Often the source of decreased tissue sensitivity to insulin is pet obesity. Another reason for the development of independent diabetes mellitus in cats is the advanced age of the animal.
Acquired after illness
This type of diabetes mellitus in cats develops after a disease that provokes abnormalities in the pancreas or metabolic disorders. This type is also curable if all doctor's instructions are followed. If you manage to overcome the primary disease, then secondary diabetes in your cat will also disappear.
Causes
There is a distinction between congenital diabetes mellitus in cats and acquired diabetes mellitus. If the animal does not have a genetic predisposition, then the disease may begin to develop for the following reasons:
- overweight;
- unbalanced diet;
- diseases of the blood vessels and cardiac system;
- chronic state of stress;
- viral infections;
- chronic diseases internal organs;
- sedentary lifestyle;
- diabetogenic effect of medications taken.
Most often, diabetes mellitus affects animals over 5 years of age. Doctors have also noticed that males suffer from it much more often than females.
Overweight
Excess body weight is the result of either overfeeding or metabolic disorders in the body. Due to a significant amount of adipose tissue, insulin insensitivity may develop. It can also cause the pancreas to not work properly. Most often, diabetes mellitus is observed in cats that have an abdominal type of excess weight, that is, one when excess fat accumulates in the abdominal area and on internal organs.
Unbalanced diet
Veterinary experts recommend making a cat’s diet from high-quality industrial dry and wet food or balancing natural nutrition. When giving a cat table scraps or foods that are unhealthy for it (fried, salted, smoked, etc.), metabolic processes in the body may begin to change. All this will ultimately lead to diabetes or other equally serious diseases.
Protein-deficient diets are especially dangerous for cats. The animal must also receive the required amount of fiber and vitamins daily.
Sedentary lifestyle
Inactivity is detrimental for a cat, as it leads to excess body weight. In combination with an incorrect feeding diet, the animal develops serious diseases quite quickly, usually by the age of 5-6 years. To increase mobility, you can use a variety of play complexes for cats.
Diseases of the blood vessels and cardiac system
Heart disease can also lead to the development of diabetes in a cat. In this case, the animal often has high blood pressure, is affected important systems the body, which reduces tissue sensitivity to insulin.
Chronic state of stress
Diabetes mellitus in cats can be caused by an increased amount of glucocorticoids and adrenaline, which develops due to stress. Also in this state, animals are prone to eating disorders; they either consume food in excess or avoid it completely. In a state of stress, the body works at its limit, so the chance of various disorders dramatically increases.
Viral infections
Decreased immunity due to a viral infection can contribute to the development of diabetes mellitus in cats. The disease also attacks important internal organs of the animal and disrupts their functioning.
Chronic diseases of internal organs
Malfunctions in the functioning of internal organs can also provoke the development of diabetes in a cat. Diseases of the liver and pancreas, as well as any chronic diseases of the kidneys or heart, are especially dangerous.
Diabetogenic effect of medications taken
Some drugs can increase the likelihood of cats developing diabetes. Taking hormones and diuretics can lead to this diagnosis. Therefore, you should not self-medicate, it is dangerous for your pet.
Symptoms
Of all the types of diabetes in cats, type 1 is considered the most rapid. Most often, at first the disease occurs unnoticed by the owners. The main symptoms of diabetes mellitus in cats, characteristic of all three types of diabetes mellitus:
- increased fluid intake;
- frequent urination;
- strong thirst;
- itching, dry skin and mucous membranes;
- increased appetite;
- weight loss;
- sleep disturbance;
- lethargy;
- visual impairment;
- convulsions.
Insulin-dependent diabetes mellitus in cats is characterized not only by severe thirst, but also by nausea or vomiting. Increased fatigue, lethargy, and drowsiness are often observed. The cat begins to eat uncharacteristic amounts of food and develops a voracious appetite. Despite eating a large amount of food, the animal rapidly loses weight and looks sickly.
With this type of diabetes, your cat not only urinates more frequently, but may also become incontinent. This usually happens at night, the animal goes to bed and wakes up on a wet bed. Because of this, itching may develop, resulting in scratching. Due to constant wetting, wounds heal poorly and become entry points for infection.
With type 2 diabetes mellitus, visual impairment in cats is common. Animals suffer from itching and skin infections. Wounds heal very slowly, causing great discomfort to the pet. Cats become sleepy, spend almost all their time lying down, and have little interest in games. Sometimes there is a decrease in the sensitivity of the legs, as well as cramps. The condition of the coat deteriorates, it becomes dull and often tangled.
If measures are not taken at this stage, the animal’s immunity is greatly reduced, and secondary infections begin to join diabetes mellitus. The cat's metabolism is disrupted and its organs begin to function incorrectly. If the owner continues to do nothing, then the animal will develop problems with the bones. They become bent and become very brittle, ultimately causing the cat to become disabled.
Diagnostics
Diabetes mellitus cannot be diagnosed based on symptoms alone, as they can be common to different diseases. The doctor may order a variety of tests, here are some of them::
- general blood analysis;
- blood chemistry;
- urine test.
In some cases, diagnosis includes a glucose tolerance test. Express urine testing using special sugar-sensitive strips is often used.
Treatment
Feline diabetes mellitus has both treatable types and non-treatable types. In any case, you need to prepare yourself for a long collaboration with a veterinarian. Only full compliance with all doctor’s instructions and a special diet will make it possible to improve the cat’s quality of life. Nutrition is especially important with this insidious disease. Unlike caring for a sick person, there are specific features of treating diabetes mellitus in cats.
As part of therapy, they are most often prescribed:
- drugs that lower blood sugar levels;
- ready-made veterinary diets for cats with diabetes;
- moderate physical activity;
- insulin.
Drugs that lower blood sugar
In the second or third form of diabetes mellitus, insulin is most often not prescribed. Initially, they try to bring blood sugar to normal with the help of medications. They gently reduce glucose levels and improve the animal’s well-being. Some of the drugs can increase the production of insulin by the pancreas.
Ready-made veterinary diets for cats with diabetes
Proper nutrition is of great importance for diabetes in cats. It should be fractional, the animal is fed often, but in small portions. The emphasis in the diet is on easily digestible forms of protein; carbohydrates are limited, but not completely eliminated.
Veterinarians recommend special dry and wet food for cats with diabetes. This will make life easier for the owner and improve the condition of the pet. Ready-made diets for cats with diabetes are completely balanced and contain everything they need. Feeding standards are on the pack, but they can be individually adjusted by a veterinarian.
Moderate physical activity
Insulin
This drug is only given to cats if standard therapy does not work. When using insulin, it is important to follow the dosage, since if the dose is exceeded, the animal may fall into a diabetic coma.
Complications
Diabetes mellitus can cause the following complications in animals::
- ketoacidosis;
- diabetic neuropathy;
- hypoglycemia;
- diabetic angiopathy;
- retinopathy;
- nephropathy;
- trophic ulcers.
Without help, your cat may develop diabetic coma.
Ketoacidosis
This condition is caused by a high concentration of sugar in the animal's blood, which causes the breakdown of fats to produce a large number of ketone bodies. This complication causes the cat to experience wild thirst. Due to intoxication, the heart rhythm is disturbed and shortness of breath appears. Without assistance, the animal may die.
Diabetic neuropathy
Because of high level If the level of sugar in the cat's blood increases, damage to the nerve endings occurs, most often in the limbs. The animal begins to tread poorly on its paws, its gait becomes uncertain and wobbling.
Hypoglycemia
With a strong decrease in blood sugar levels, hypoglycemia, a diabetic coma may occur. The cat begins to experience anxiety, muscle tremors, and possible loss of consciousness.
One of the common diseases of the endocrine system associated with disruption of hormone production is diabetes mellitus. This disease in Lately is increasingly being diagnosed in domestic cats. Just like in humans, several forms of the disease occur in animals. Timely diagnosis and early treatment are the key to returning your pet to normal existence and a long life.
The disease develops due to insufficient production of insulin by special cells of the pancreas or when there is a malfunction in the body when the produced hormone goes unnoticed by target cells. At the same time, the level of glucose in the blood sharply increases in the body. Functions are impaired not only buffer system body, but also almost all organs and tissues.
Veterinary experts believe that the reasons leading to this condition include the following factors:
A contributing factor in the mechanism of pathology is. Psycho-emotional overexcitation of the animal’s nervous system leads to malfunctions of the endocrine glands, disruption of hormone production, and pathology of the digestive system.
Types of diabetes in cats
Metabolic disease is characterized by different pathogenesis and in this regard can occur in the first and second types. Development of type 1 pathology is associated with a functional change in the pancreas, in which the death of all beta cells that produce insulin occurs. This type of disease is extremely rarely diagnosed in domestic cats.
Insulin-dependent pathology is associated with the impossibility of normal functioning of the pancreas and requires replacement hormone therapy. Owners of furry pets should know that this is one of the most dangerous types of disease. Clinical signs appear already at the stage of extensive destruction of pancreatic secretory cells, and the prognosis is often unfavorable or cautious.
Development of the disease according to the second type associated with insufficient production of insulin by specific gland cells. In this case, the glandular tissues of the organ do not die, but the amount of hormone produced is not enough for the normal functioning of the body. This type of pathology, as a rule, does not require the use of hormonal drugs.
The second type of diabetes occurs in 70 - 80% of cases. However, if measures are not taken in a timely manner, the pathology can become insulin-dependent - the first type of illness.
Some experts tend to identify a third type of disease, combined. This form of the disease is associated with both the destruction of beta cells and insufficient production of insulin by healthy gland tissue. The cause of endocrine disruption is most often inflammatory diseases of the pancreas. This type of diabetes is called secondary.
Disease statistics
Domestic and foreign veterinary experts have noted an increase in diabetes mellitus among domestic cats over the past few years.
This is associated not only with the prevalence of the disease, but also with the expansion diagnostic procedures in veterinary practice. According to statistical studies, 2 cats out of 1000 are susceptible to endocrine disease.
At the same time, veterinarians observe sex dependence in the formation of pathology: cats, unlike cats, are more likely to suffer from diabetes. It was also noted that the risk of developing the disease increases in castrated males. Experts associate this phenomenon with obesity. Pathology developing according to the second type accounts for approximately 2/3 of all cases.
According to statistics, the first symptoms of the disease in 50% of cases are found in pets after 5 years. The older the animal, the greater the likelihood of detecting an endocrine disease. It has also been noted that cats of the Burmese breed are more often than others susceptible to this pathology.
Symptoms of diabetes in cats
Clinical signs largely depend on the type of disease. So, with an insulin-dependent form, the owner can observe the following symptoms in the pet:
A) Obesity. B) Diabetic neuropathy. With the development of the second type of disease, the following clinical manifestations are observed in a sick animal:
- Increased appetite.
- Rapid weight gain, obesity.
- Polydipsia. The animal constantly drinks water.
- Frequent, painless urination.
- The pet's condition is usually satisfactory.
Unlike type 1 diabetes, the non-insulin-dependent form is not accompanied by the smell of acetone from the animal.
Diagnosis of diabetes mellitus in cats
It is impossible to make a correct diagnosis based only on clinical signs with such a complex disease. Clinical and laboratory methods for examining the pet’s blood and urine come to the rescue.
When analyzing biological fluids, one of the indicators of the disease is excess glucose levels in the blood and the presence of sugar in the urine.
In addition to determining the glucose concentration, a general blood test, insulin determination, and acid-base balance are performed. It is important for the owner to know that all tests must be taken only on an empty stomach.
The veterinarian will also instruct you to determine the amount of water your pet is consuming. In order to establish the pathology of the pancreas, an ultrasound examination is performed. For a differentiated diagnosis, an examination of the heart, liver, and digestive organs is performed.
To learn how to properly use a glucometer in cats, watch this video:
Treatment of diabetes mellitus in cats
The treatment strategy for endocrine disease depends primarily on the type of disease. Thus, in type 1 diabetes mandatory insulin medications are prescribed short acting. In the case of the development of the second type of disease, hormones can be replaced with glucose-lowering drugs, or medium- or long-acting insulin can be prescribed.
Sugar-lowering tablets
Drugs that lower blood glucose levels are prescribed for the second and third types of the disease. The products effectively reduce the concentration of sugar in the body, reduce its negative impact on organs and systems, and improve the condition of the body as a whole. Used for cats medical supplies, such as Metformin, Glipizide, Gliquidone, Miglitol.
Antihyperglycemic drugs Insulin injections
The use of hormones is associated with difficulties in determining the optimal dose. To do this, in a clinical setting, blood glucose levels are measured within 18 to 24 hours after the administration of a certain dose of insulin. The time, duration and strength of action of the hormonal drug are determined. Based on these data, the veterinarian will draw up a regimen for using insulin in a particular case.
For information on the symptoms, diagnosis and treatment of diabetes in cats, watch this video:
Complications of diabetes in cats
The insidiousness of endocrine disease lies not only in the invisibility of clinical signs, but also in the severity of the complications that the pathology leads to. A high concentration of glucose in body fluids has a destructive effect on almost all systems of a sick animal.
Ketoacidosis
Dyspnea When glucose concentrations are high, the animal develops diabetic ketoacidosis. The condition is characterized by a high level of ketone bodies in the blood, which are products of fat breakdown.
Clinically, the phenomenon is manifested by a pungent odor of acetone from a sick pet, irrepressible thirst, shortness of breath, and cardiac dysfunction.
Without urgent veterinary care, the severe condition of the body with diabetic ketoacidosis often leads to the death of the animal. You can bring your pet back to life only with insulin and infusion therapy.
Diabetic neuropathy
High concentrations of glucose in the blood lead to damage to peripheral nerve endings. This phenomenon manifests clinically as weakness of the hind limbs. The animal has an insecure unsteady gait. A sick cat begins to walk on its entire foot, without stepping on its toes.
Hypoglycemia and hypokalemia
A decrease in glucose levels below 3.3 mmol/l is called hypoglycemia and is a consequence of high levels of insulin in the animal’s body. Symptoms of hypoglycemia are as follows:
- anxious, excited state of the animal;
- muscle tremors, tremor of individual muscles;
- loss of coordination of movement, unsteadiness of gait;
- lethargy, drowsiness;
- fainting, loss of consciousness.
For the animal, the danger of the phenomenon is the development of hypoglycemic coma and death. At home, you need to urgently increase your blood sugar levels. For this purpose, a concentrated sugar solution is poured into the cat’s mouth or 10 ml of 5% glucose is injected subcutaneously. The animal must be urgently taken to a specialized facility.
Hypokalemia, characterized by a decrease in potassium concentration, is due to several reasons. Firstly, frequent urination facilitates the removal of the element from the body. Secondly, insulin injections lead to intensive consumption of potassium by the body's cells.
As a result, a serious condition develops in the sick animal. Vomiting, diarrhea are observed, and acute heart failure develops. If urgent qualified assistance is not provided, death occurs.
How to control your cat's sugar levels
After establishing a diagnosis and prescribing treatment, the owner of a sick animal faces important task– control of sugar levels in biological fluids. The most common way to monitor at home is test strips for determining sugar in urine. With their help, the owner has an idea of the animal’s condition and can adjust the diet or take appropriate measures.
More precise method control are veterinary glucometers. They are used in severe cases of diabetes, when it is necessary to have a clear understanding of the sugar level in the body.
Nutrition rules and food selection for a cat with diabetes
Besides drug treatment a lot of sick cats important is given to dietary nutrition, which is prescribed by the attending physician, taking into account individual indicators pet's sugar. The diet should be rich in protein foods. Particular importance is given to fiber. Dietary fiber slows down the release and absorption of glucose into the blood. Carbohydrates are given to the animal to a minimum.
A sick pet should be fed in small portions, 5-6 times a day. This mode allows you to relieve the load on the pancreas and helps maintain the concentration of glucose in the blood at a constant level throughout the day.
A veterinarian may prescribe professional medicinal feed. Typically written out dietary food is lifelong.
Cat food for diabetes Diabetes in domestic cats is one of the complex diseases associated with metabolic disorders. Endocrine disruption leads to the development pathological processes in almost all organs and systems of the body. If diagnosis and treatment are not timely, complications can lead to fatal outcome. The owner must understand the danger of the disease and provide the pet with qualified assistance and competent care.
Diabetes mellitus in cats is a disease of the pancreas. This small organ, located next to the stomach, is made up of two different types of cells that have very different functions. One group of cells produces enzymes necessary for proper digestion. The other group is beta cells, they produce the hormone insulin, which regulates the level of glucose (sugar) in the blood and controls its delivery to body tissues. Simply put, diabetes is caused by a deficiency of insulin. The clinical signs that appear in diabetes mellitus are associated with increased concentrations of glucose in the blood and the body's inability to use this glucose as an energy source.
Different types of diabetes in cats
Diabetes mellitus is usually divided into 2 types:
- Type I - in this case, complete or almost complete death of beta cells occurs. Fortunately, this type of diabetes is extremely rare.
- Type II is characterized by the fact that some beta cells continue to function normally and secrete insulin. However, there are too few of them, the amount of insulin produced is not enough. The most common sign of this type of diabetes in cats is obesity.
How common is diabetes in cats?
Diabetes mellitus is one of the most common endocrine diseases in cats. According to some estimates, one in four hundred cats suffers from this disease.
- The first clinical signs most often begin to appear at 5-6 years of age or in old age.
- Males are more prone to the disease than cats.
- The exact figures for the dynamics of the manifestation of diabetes mellitus in these animals are unknown. However, the number of affected cats is growing at an alarming rate every year due to a massive increase in the number of overweight and obese pet cats.
It is important to note that a cat weighing 1.5 kg more than its ideal weight may already be considered obese. This means that the average domestic cat who weighs 6 kg or more is at risk for developing type II diabetes.
Please note that we are not talking about giant breeds of cats, such as the Maine Coon. For such animal breeds the numbers should be increased.
Clinical signs of diabetes mellitus
The most common symptoms of diabetes in cats are:
- strong thirst;
- frequent urination.
Against the background of these signs, weight loss and increased appetite are observed. Due to the specific behavior of cats, these signs may for a long time remain unnoticed, especially on early stages diseases.
- If an animal spends a lot of time outdoors, it can find a source of drink anywhere, as well as relieve itself without being noticed.
- Pets that eat canned or natural foods get most of their fluids from their diet and increased water intake will not be as easy to notice.
How is diabetes diagnosed?
The diagnosis of “feline diabetes” is made on the basis of:
- medical history;
- clinical signs;
- persistently high concentrations of glucose in the blood;
- in the presence of glucose in the urine.
However, the diagnosis should not be made on the basis of a one-time blood and urine test, since some factors can cause a one-time increase in sugar levels, for example, due to stress. Therefore, to confirm or refute the diagnosis, blood and urine are given up to 5 times daily.
Treatment of diabetes in cats
Some diabetic cats require insulin injections.If certain nuances are followed, diabetes in cats can be treated. Although this is a very long process, requiring patience and the desire from the owner not to deviate from the intended goal, no matter what.
- First, you need to completely eliminate all factors that cause the manifestation of signs of diabetes. For example, if a cat is systematically given any medications that can provoke the development of diabetes, their use should be stopped. Obese cats are more likely to develop diabetes, and forced weight loss may improve the situation in some animals.
- All cats with diabetes should always receive a balanced diet; The most convenient way to select it is to use it with a high protein content and low carbohydrate content. Low carbohydrate content reduces the amount of glucose absorbed from gastrointestinal tract and reduces the body's need for insulin.
If predisposing factors cannot be identified or their correction does not lead to desired result, you can still help the animal without resorting to complex treatment regimens:
- Some cats will respond well to hypoglycemic medications.
- Some will require insulin injections.
At the initial stages of treatment, you will have to visit a veterinarian several times, who will select the optimal dosage specifically for a particular cat. In most cases, it takes several days to several weeks for the animal to stabilize. During this time, the owner will need to administer insulin to the cat 1 or 2 times a day, as recommended by the veterinarian. The needles used for such injections are very small and do not cause much discomfort to the animal, so this procedure soon turns into a routine. During follow-up visits with your doctor, you can adjust the dose of the administered drug, if necessary.
Important! Never change the insulin dosage yourself, without the advice of your veterinarian.
Treatment control
To monitor treatment and confirm its effectiveness, the veterinary doctor will periodically prescribe scheduled blood and urine tests. Thanks to the results of the examination, it will be possible to change the frequency of administration of the drug or its dosage.
The owner’s daily notes, containing the following information, will play a special role in adjusting the treatment by the veterinarian:
- Insulin administration time.
- The amount of insulin that was administered.
- The time and amount of food that was offered to the cat, as well as the amount that it ate.
- Amount of water.
- Cat's weight (daily).
In addition to blood testing, monitoring the animal's urine test is important. Changes in urine sugar levels may be the reason for adjusting the dosage of administered insulin and checking the effectiveness of its use.
Night or morning urine is best suited for analysis. Various methods can be used to collect material:
- It is very convenient if the cat can go to the tray without sand, but with a special grid.
- Europeans suggest using sterilized aquarium gravel instead of regular cat litter for litter boxes. This gravel is not absorbent and the urine will flow to the bottom of the tray, where it can be drained into a clean container for testing.
- As a last resort, you can resort to placing a genitourinary catheter to collect urine. But this method has a number of disadvantages in this situation, since analysis must be taken quite often, and a genitourinary catheter cannot be placed in an animal without prior sedation. That is, you will have to subject the cat to the administration of potent drugs many times. sedatives and mechanically injure the ureter by inserting a catheter.
If there are noticeable changes in glucose levels, it becomes necessary to adjust the administered dose of insulin, so it is important to carry out the analysis as often as possible, according to the recommendation of the veterinarian. But you should never make adjustments at your own discretion, without consulting your veterinarian. Most likely, your glucose reading will change every day, which is why adequate help and advice from a specialist is so important.
Insulin overdose
An overdose of insulin can lead to very low glucose readings in tests. For this reason, it is important to be very careful when prescribing insulin dosage for a sick cat.
Typical symptoms indicating a drop in glucose levels:
- weakness and lethargy;
- trembling, convulsions;
- unsteadiness of gait.
If a diabetic cat exhibits one or more of these symptoms, you should immediately contact your veterinarian for advice.
In mild cases of hypoglycemia, nervous tics or a drunken gait may occur. Then you can provide first aid to the animal by pouring about a tablespoon of corn syrup, liquid honey or sugar solution into the mouth from a syringe without a needle.
The tandem of a competent veterinary medicine specialist and a patient, meticulous owner in treating a cat with diabetes will save and prolong its life.
KotoDigest
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Authors): ON THE. Ignatenko, Ph.D., member of the European Society of Dermatology, member of the European Society of Endocrinology, Kiev, Ukraine / N. Ignatenko, Member of ESVD, ESVE, Kiev, Ukraine
Magazine:
№5 - 2014
UDC 616.379-008.64:636.8.045
Keywords: diabetes mellitus in cats, remission of diabetes mellitus, hyperglycemia, hypoglycemia, insulin therapy, diet, exercise
Key words: diabetes mellitus in cats, remission of diabetes mellitus, hyperglycemia, hypoglycemia, insulin, diet, exercise
annotation
Diabetes mellitus in cats is a common endocrine disorder. The difficulty in recognizing a severe endocrine disorder leads to frequent errors in home therapy for diabetic cats. Five short steps allow you to consistently understand the issues of etiology, clinical manifestations, diagnosis, important aspects of therapy and prognosis of diabetes mellitus, and also facilitate the path to achieving remission, which is the most desirable goal of therapy in diabetic cats.
Diabetes in cats is a common endocrine disorder. The complexity of perception of severe endocrine disorder resulting in frequent errors in home therapy diabetic cats. Five short stages allow consistently deal with issues of etiology, clinical manifestations, diagnosis, therapy and the important points of the forecast of diabetes. And also make it an easier way to achieve remission, which is the most desirable goal in cats with diabetes.
Diabetes mellitus in cats is a disease that is characterized by a relative or absolute deficiency of insulin and leads to the development of persistent hyperglycemia. It is generally accepted that diabetes mellitus is primarily a problem for old elderly cats, since cats under one year of age are 50 times less likely to develop diabetes mellitus than cats over 10 years of age. Males are more likely than cats to suffer from this disease, but, nevertheless, in the routine practice of a veterinarian, it is becoming more common (if earlier foreign statistics spoke of one case of the disease per 1000 cats, then the modern one indicates that diabetes mellitus may occur in one in 200 cats admitted). Therefore, we can encounter this disease at any time. age group of any gender and breed and must be prepared to recognize it by its characteristic clinical signs.
1. Clinical picture(What's going on with my cat?)
The clinical signs of diabetes mellitus, unlike many endocrine pathologies, are quite characteristic, and we can also count them on the fingers of one hand:
Polydipsia;
Polyuria;
Polyphagia;
Fluctuations in weight;
In more rare cases with long-term diabetes mellitus, peripheral neuropathy manifests itself in a strange plantigrade gait. Cataracts, which are common in diabetic dogs, are not common in diabetic cats. However, it should be remembered that such clinical signs can be observed not only in diabetes mellitus, so it is imperative to carry out differential diagnosis disturbing symptoms. We discussed it in detail in No. 4 of the VetPharma-2013 magazine, so I would just like to remind you about hyperthyroidism and chronic renal failure, which are no less rare findings in older cats.
The development of diabetes mellitus in cats is associated with two mechanisms:
1. violation functional state beta cells of the pancreas, as a result of which the synthesis and release of insulin and aniline is disrupted;
2. the occurrence of insulin resistance, which leads to impaired utilization of nutrients in tissues sensitive to it. The consequence of these factors is the accumulation of amyloid in the islets of Langerhans; a similar mechanism for the development of type II diabetes mellitus has been described in humans. Just as in humans, one can distinguish between conditionally insulin-dependent, or type I diabetes mellitus, and non-insulin-dependent, or type II diabetes mellitus. As well as transient diabetes mellitus, which can occur against the background of another disease, such as pancreatitis, and go away with effective treatment. Most cats have type II diabetes, but insulin therapy will be a mandatory component of treatment, which we will discuss later.
2. Reasons(Why is my pet sick?)
There is no one unconditional factor that could be called the root cause of diabetes in cats, but it will be easy for owners to name the “top five” among the contributing factors:
Being overweight;
Pancreatitis;
Drug therapy using progestogens and glucocorticoids;
Concomitant diseases: hyperlipidemia, liver diseases, cardiovascular diseases, chronic renal failure, infectious pathology, etc.;
Competitive endocrine disorders (hyperthyroidism, acromegaly).
The importance of genetic predisposition to diabetes mellitus in cats remains controversial. The latter plays a key role in the development of type I diabetes mellitus in humans, but its significance has not been proven in cats.
3. Diagnostics(How can I be sure that my four-legged family member has diabetes?)
Diabetes mellitus is rare endocrine pathology, the diagnosis of which is not difficult: for this we only need the triad:
Characteristic clinical signs;
Hyperglycemia (high blood glucose levels);
Glucosuria (appearance of glucose in the urine).
However, cats, unlike dogs and people, may experience stress hyperglycemia due to blood draws or other illnesses, glucose levels during normal indicators up to 6.2 mmol/l can increase to 20 mmol/l. If stress hyperglycemia is so high, then glucose may also appear in the urine (which is unusual for humans and dogs), since with glucose above 10-13 mmol/L in the blood, it will pass through the renal barrier and appear in the urine. Therefore, sometimes, in addition to the listed three components, which in most cases are sufficient, sometimes two more may be needed: determination of glycosylated hemoglobin and fructosamine.
Glycosylated hemoglobin and fructosamine are formed as a result of irreversible nonspecific binding of glucose by amino acid residues. The level of their concentration in the blood is directly proportional to the average concentration of glucose in the blood over a certain period of time, and their content is determined general level recycling of the corresponding proteins, which is shorter for whey proteins than for hemoglobin.
Fructosamine is a complex of glycosylated whey proteins, the concentration of which can be determined using a colorimetric assay, which serves as a marker reflecting the average glucose concentration of cats over the past 10-14 days. Glycosylated hemoglobin is a product of the interaction of hemoglobin and glucose, its concentration is determined using chromatography - the concentration in the blood reflects the average level of glucose in the blood over 60-70 days in cats, in contrast to dogs and people, in whom it is considered to reflect the level of glucose over 110 -120 days. Anemia (Ht< 35), гипопротеинемия будут приводить к занижению этих показателей, а хранение проб крови при комнатной температуре – к завышению. Об этом необходимо помнить при интерпретации показателей. Стоит обратить внимание на то, что показатели гликозилированного гемоглобина у кошек значительно ниже, чем у людей (Table 1). The cause of lower glycosylated hemoglobin in cats is unknown. It is believed that this is a consequence of the shorter lifespan of red blood cells in cats, different permeability of red blood cell membranes to glucose, or differences in the amino acid composition of hemoglobin in animals of both species, as well as people, which determine the number of glucose binding sites.
4. Therapy(How to cope with diabetes?)
Once the diagnosis has been made, it is very important to explain to the owner of a diabetic cat that the success of therapy will depend solely on the joint efforts of the doctor and owner, and to strive to achieve maximum mutual understanding. By formulating the goals and objectives that we expect to achieve when starting therapy in diabetic cats, we want not only to eliminate the symptoms of diabetes mellitus, avoid ketoacidosis, as well as other complications and late consequences of diabetes mellitus, but also to achieve remission.
Remission is a decrease in insulin requirements associated with improved function of the remaining beta cells. Partial clinical remission is a significant reduction in the insulin dose (less than 0.4 U/kg per day). Complete clinical remission – no need for exogenous insulin administration. It is assumed that the damaged pancreas in cats, like the liver, is capable of regeneration within 8-12 weeks. Hyperglycemia temporarily suppresses insulin secretion + amyloid deposition leads to the destruction of beta cells. By starting insulin therapy, we remove the factor of the toxic effect of glucose, allowing the pancreas to regenerate. Euglycemia, achieved through insulin therapy + a low-carbohydrate diet 24 hours a day, promotes the regeneration of the pancreas, but tissue resistance to insulin remains for some time. Continuation of therapy leads to a decrease in oxidative stress, a decrease in insulin resistance and a decrease in insulin dosage. Long-term euglycemia leads to recovery of the pancreas. There are high chances of achieving remission in cats with newly diagnosed diabetes mellitus if therapy is quickly started, as long as residual secretion of beta cells is preserved and amyloid deposits in the pancreas are not critical.
The most important components of treating diabetes mellitus in cats in order to achieve remission are:
Insulin therapy started as early as possible;
Intensive monitoring of glucose levels during dose selection;
High protein diet;
Physical exercise;
Stabilization of other chronic diseases leading to deterioration in the health of diabetic cats.
I would like to dwell on each of these points in a little more detail.
Many cat owners, having heard that their pet has type II diabetes mellitus, try to draw an analogy with people, asking not to prescribe insulin to their animal, fearing that in this way they will suppress the secretion of their own insulin, and simply demand glucose-lowering tablets. But they do not understand the mechanism of action of these drugs, often thinking that this is a different form of release, the so-called insulin tablets. Therefore, at the first appointment it is very important to explain to the owner that hypoglycemic drugs all 5 groups that are used in humans (sulfonylureas, thiazolidinediones, meglitinides, biguanides and alpha-glucosidase inhibitors) will not improve the functioning of the pancreas; on the contrary, sooner or later they will lead to its complete depletion. While properly selected insulin can help the pancreas recover, if the process is still reversible.
The best drugs for the treatment of diabetes mellitus in cats are analogues of long-acting insulin: Lantus, which is recognized as the first choice insulin for diabetic cats, and Levemir, on its use for cats there are fewer published ones yet clinical trials, but the results are also encouraging. Therefore, if the duration of action of Lantus is too short, or there are contrainsular diseases, then it is necessary to try the use of Levemir. Dosing of lantus starts with 0.5 units per kg of body weight of a cat, but not more than 2 units during the first administration. You should start using Levemir in lower dosages: from 0.1-0.2 units per kg.
Insulins are not antibiotics, and their duration of action varies individually: there are patients for whom the drug works for 12 hours, and others for whom it works for 18-24 hours. Less common are cats in which insulin analogues work for 8 hours, and in this case it is necessary to either inject insulin every 8 hours or choose insulin that will work longer. Less effective with a shorter duration of action in cats are NPH insulins with an intermediate duration of action or mix insulins, which combine insulin of a short and medium duration of action. With these insulins it is much more difficult to achieve a stable course of diabetes mellitus, and therefore achieve remission.
It is very difficult for the owner of a newly diagnosed diabetic patient to assimilate such large amounts of information at one time, so he needs constant support from the medical staff until he learns to independently grasp the patterns of insulin administration frequency and dosage.
A simpler and more preferable option, at first glance, would be to leave a newly diagnosed diabetic cat in the clinic to determine the dose of insulin and the duration of its action. However, cats in the clinic are under a lot of stress, which can increase stress glycemia, and many of them do not want to eat in the clinic, which also makes dose adjustment difficult. Therefore, if the cat feels clinically well, its appetite is preserved, and there are no clinical and laboratory signs of ketoacidosis or impending hyperosmolar coma, then it is better to adjust the dose of insulin at home.
Before the owner of a diabetic cat picks up a syringe on his own, you must be sure that the owner knows which one he needs. insulin syringe, and later, when purchasing at a pharmacy, he will choose the right one. Long-acting insulin analogues, such as Lantus and Levemir, are available in syringe pens, 1 step in them is 1 unit, and this is very convenient for dosing, except in cases where the insulin dose is 1.5-2.5, etc. d. Unit In this case, it will be more useful to use insulin syringes with 0.5 or 0.3 U U100 (1 ml - 100 units of active action).
It is also worth remembering that there are different places for injecting insulin in cats, and the skin in the withers area is thicker than the skin in the inguinal fold area. It is important to warn the owner and ask him to practice, under the supervision of a doctor, collecting insulin on his own (this will minimize the likelihood of an insulin overdose) and injecting it (it is important to teach how to inject subcutaneously and not intradermally, since in this case there will be inadequate resorption of insulin, and not intramuscularly, otherwise insulin will be work like short-acting insulin).
After the manipulation (measuring glucose or administering insulin), it is worth rewarding the animal for its good behavior ( Photo 5-9).
However, when leaving the appointment, the owner must first learn, under the supervision of a specialist, and then independently measure glucose levels. The optimal sites for collection from cats are the ears and paw pads. The latter, however, cannot be called an ideal place for taking blood due to the potential threat of infection in those cats that scoop in the toilet. It is necessary that owners independently in the clinic master simple procedures for drawing blood, observing some small subtleties (warming the ear, applying a drop of Vaseline oil first, using only special lancets for drawing blood, as well as squeezing out a drop with a volume of at least 5 μl to completely fill the capillary test strips), they can easily monitor glucose levels at home and, based on the results, select the dose and time of administration.
It is important to warn the owner that it is necessary to place a cotton pad between the ear and his own finger so as not to pierce his finger, and to press the lancet tightly to the ear.
A drop of blood has been received, now you need to bring a glucometer with a test strip to it to get the result ( Photo 10-14).
For the first week, so that the owner feels more confident, you can draw insulin into syringes in the clinic, and the owner of the house will only inject it, then the likelihood of an error will be lower. It is very important that when starting insulin therapy, the owner understands that 1 unit and 0.1 ml are not synonymous words! And insulin dosage is never carried out in ml, only in units of active action! When we begin intensive monitoring of a diabetic cat, we aim to restore his pancreas and achieve remission, meaning that as the beta cells recover, the need for exogenous administration will decrease and the insulin dose will need to be lowered. The goal is to achieve indicators of 6-10 (up to 12) in diabetic cats. Because of this, owners may experience episodes of hypoglycemia and must be able to recognize and respond appropriately to them. If the pet owner does not confuse the insulin dose and if the cat eats adequately, then episodes of severe hypoglycemia when using long-acting insulin analogues are rare. But an important message: if a diabetic cat behaves inappropriately: it is too active or, on the contrary, passive, it has an increased appetite or impaired reaction, it staggers or does not respond to stimuli, the first thing is to measure sugar and make sure that the animal does not have hypoglycemia . If the glucose level drops below 4 mmol/l, then it is necessary to urgently feed the animal and repeat the glucose measurement after 30 minutes. If the glucose level is below 3 mmol/l, and the cat has clinical signs of hypoglycemia, then it should immediately lubricate the gums with honey or glucose syrup (while the animal is swallowing) and bring it to the clinic as soon as possible. If a cat has no clinical signs of hypoglycemia, and a medical glucose meter shows less than 2 mmol/l, then this may be due to the fact that humans and animals have different glucose distributions. In humans, the glucose content of red blood cells is 42%, while 58% of glucose is in plasma.
In cats (fewer red blood cells, which are small in size), the glucose content in red blood cells is about 7%, and 93% of glucose is in the blood plasma, so a medical glucometer shows a lower value than it actually is. If the cat is not showing clinical signs of hypoglycemia and the veterinary glucometer shows a glucose level of less than 2 mmol, then it is important to ensure that the capillary of the test strip is completely filled with blood. Incomplete filling of the capillary due to a small drop may lead to an underestimation of the result. In this case, the glucose measurement should be repeated.
If the same dose of insulin begins to work longer over time and reduces glucose levels below 4 mmol/l, then this is one of the signs of approaching remission. It is important not to miss it and to constantly reduce the dose and increase the interval. If glucose is measured only once a day before insulin administration, then it is possible to miss an episode of post-hypoglycemic hyperglycemia and increase the dose when it needs to be reduced. In this case, a chronic increase in dose can lead to the development of insulin resistance - Somogyi syndrome. Characteristic clinical signs Somogyi syndrome are persistent hyperglycemia with indicators of uncompensated diabetes mellitus against the background of insulin therapy, persistent polydipsia, polyuria, polyphagia and lack of weight loss, and sometimes further weight gain. It is very important to identify this condition promptly (by serially measuring glucose levels every 4 hours) and select the correct dose of insulin.
Cats are obligate carnivores, therefore, for a stable course of diabetes mellitus and achieving remission, it is important to choose a high-protein diet for the animal, in which the protein content will be at least 45%. It is preferable to use wet food. Since most diabetic cats suffer from excess weight, the diet should be aimed at reducing and preventing it. The content of arginine, which increases the secretion of endogenous insulin, is an additional advantage in the direction of high-protein nutrition.
Studies conducted to examine the effects of high-protein diets on kidney function have shown that they do not worsen renal function tests (urea, creatinine, phosphorus) in cats and do not worsen the condition of patients with kidney disease. initial stage chronic renal failure. But it cannot be used in patients with already severe renal failure. It is advisable to feed cats with diabetes twice a day, along with insulin or after its administration. However, there are animals, for example in old age, which are very difficult to retrain to switch to a different type of food. In this case, it is worth trying to give the main portions of food with insulin, and leave a smaller amount of the daily ration for snacks. It is very important not to overfeed a diabetic cat, which at the very beginning, when severe symptoms polyphagia is very difficult. But excess weight is a factor that not only contributes to the development of diabetes, but also provokes insulin resistance, so it is very important for owners of cats suffering from diabetes to convey the message about the need to reduce excess weight in their pets.
“What to do if insulin doesn’t work?” owners often ask. The most important reason for the ineffective action of insulin is the owner of the animal, so first of all it is necessary to check the accuracy of the dose, the correct administration and storage conditions of the insulin. If everything is done correctly, then try to change the dose. If a cat receives more than 2 units per kg of lantus or levemir, and glucose levels remain high, then we are talking about insulin resistance and should try to find out its causes. Of the endocrine disorders, antagonistic diseases can primarily be hyperthyroidism and acromegaly; hyperadrenocorticism is very rare in cats. But even such routine diseases as asymptomatic chronic cystitis can cause insulin resistance, so at the stage of the first clinical studies it is important to create the most complete overall picture of the health of a cat suffering from diabetes.
In addition to the correct dose selection of long-acting insulin analogues and high-protein nutrition, it is very important to get the cat moving. Physical activity is also a necessary point in increasing tissue sensitivity to insulin. Therefore, it is important to discuss with the owners all the possibilities of how to make the cat move more: you can put food little by little in different parts of the kitchen, buy toys in which you can pour food, and the cat will require physical effort in order to get it, from running after laser pointer to catching virtual fish on a tablet - all means are good.
5. Forecast(How long will my pet live after he gets diabetes?)
The prognosis for any diabetic animal is unpredictable. Much depends on the owner (degree of attachment, willingness to devote time to treating and monitoring the pet), the presence and severity of concomitant disease. According to statistics from foreign authors, 50% of cats diagnosed with diabetes mellitus die within 12-17 months after diagnosis (including aggravating diseases). Nelson writes: "... in cats surviving the first 6 months after diagnosis of diabetes mellitus, good quality life is preserved for more than 5 years, despite the disease...”
The owner must remember that weight loss helps to lengthen life expectancy. Modern sources are more optimistic about the life expectancy of diabetic cats: the median is 516 days. And, in my opinion, these indicators will improve as intensive home monitoring and therapy with long-acting insulin analogues improve. Early initiation of insulin therapy helps achieve remission in 70-80% of cats with newly diagnosed diabetes mellitus. The prognosis is worsened by chronic renal failure, as well as previous ketoacidotic or hyperosolar coma. But more about this in the next issues of the magazine.
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