Diabetes in cats and dogs: Wikis

Advertisements
  

Note: Many of our articles have direct quotes from sources you can cite, within the Wikipedia article! This article doesn't yet, but we're working on it! See more info or our list of citable articles.

Encyclopedia

From Wikipedia, the free encyclopedia

Diabetes mellitus strikes 1 in 400 cats and a similar number of dogs, though recent veterinary studies[1][2] [3] note that it is becoming more common lately in cats. Symptoms in dogs and cats are similar to those in humans. Generally, most diabetic dogs experience type-1 (insulin-dependent) diabetes, rather than the type-2 that's now becoming common in obese humans. 80-95% of diabetic cats experience type-2 diabetes.[4] but are generally severely insulin-dependent by the time symptoms are diagnosed. The condition is definitely treatable, and need not shorten the animal's life span or life quality. In type-2 cats, prompt effective treatment can even lead to diabetic remission[5], in which the cat no longer needs injected insulin. Untreated, the condition leads to cataracts in dogs, increasingly weak legs in cats and dogs[6], and eventually malnutrition, ketoacidosis and/or dehydration, and death.

Contents

Symptoms

Cats and dogs will generally show a gradual onset of the disease over a few weeks, and it may escape notice for a while. The condition is unusual in cats less than seven years old. Diabetes is mainly a disease of middle-aged and older dogs[7], but there are juvenile cases also[8]. The first obvious symptoms are a sudden weight loss or gain, accompanied by excessive drinking and urination; for example, cats can appear to develop an obsession with water and lurk around faucets or water bowls. Appetite is suddenly either ravenous (up to three-times normal) or absent. In dogs, the next symptom is vision problems and cataracts, while in cats the back legs may become weak and the gait may become stilted or wobbly (peripheral neuropathy). A quick test at this point can be done using urine keto/glucose strips (the same as used on the Atkins diet) with the animal. If the keto/glucose strips show glucose in the urine, diabetes is indicated. If a strip shows ketones in the urine, the animal should be brought to an emergency clinic right away. Testing can also be performed with a home glucose meter by obtaining a blood sample with a lancet via an ear prick, paw prick or, in dogs, a lip prick.

Owners should watch for noticeable thinning of the skin and apparent fragility: these are also serious and indicate that the animal is metabolizing (breaking down) its own body fat and muscle to survive. Lethargy or limpness are acute symptoms indicating likely ketoacidosis and/or dehydration and demand emergency care within hours.

Treatment

Diabetes can be treated but is life-threatening if left alone. Early diagnosis and treatment by a qualified veterinarian can help, not only in preventing nerve damage, but in some cases, in cats, can even lead to remission.[9][10] Cats usually seem to do best with long-lasting insulins and low carbohydrate diets[11], while dogs have varying "best" insulin treatments depending on the individual case.[12]

Advertisements

Diet

Diet is a critical component of treatment, and is in many cases effective on its own. For example, a recent mini-study[13] showed that many diabetic cats stopped needing insulin after changing to a low carbohydrate diet. The rationale is that a low carbohydrate diet reduces the amount of insulin needed and keeps the variation in blood sugar low and easier to predict. Also, fats and proteins are, in dogs and perhaps cats, turned into blood glucose much more slowly and evenly than carbohydrates, reducing blood-sugar highs right after mealtimes.

Latest veterinary good practise is to recommend a low carbohydrate diet for cats[14][15], and a high-fiber, moderate-carb diet for dogs. In dogs another alternative is to feed a normal healthy diet but give mealtime insulin bolus supplements. Dogs with pancreatitis, a fairly common condition for diabetic dogs, often need a restricted-fat diet.[16]

It's now becoming clear that lower carbohydrate diets will significantly lower insulin requirements for diabetic cats. Carbohydrate levels are highest in dry cat foods (even the expensive "prescription" types) so cats are best off usually with a low carbohydrate healthy canned diet. Some prescription canned foods made for diabetic cats are effective, but some ordinary ones work just as well. Between 3 and 9% calories from carbohydrates seems to be optimal. You can use the cat food calculator found at http://www.scheyderweb.com/cats/catfood.html to determine the carbohydrates and calories in any cat food, though numbers in American brands are given as minimums and maximums rather than actual estimates, and may be very inaccurate. These commercial food contents listsare kept up-to-date with actual manufacturer's as-fed content amounts.

Pills

Oral medications like Glipizide that stimulate the pancreas promoting insulin release, (or in some cases, reduce glucose production) work in some small proportion of cats (Most dogs are Type I diabetics so oral hypoglycemic drugs are not effective for them)[17], but these drugs may be completely ineffective if the pancreas is not working. Worse, these drugs have been shown in some studies[18] to damage the pancreas further, reducing the chances of remission for cats. They have also been shown to cause liver damage. Many are reluctant to switch from pills to insulin injections, but the fear is unjustified; the difference in cost and convenience is minor, (many cats are easier to inject than to pill) and injections are more effective in almost all cases.

Insulin injections

Humans with Type-1 diabetes are often treated with a "basal plus bolus" method, where a long-acting insulin is injected once or twice daily to provide a "basal" insulin level, then shorter-acting insulin is used just before mealtimes.

For cats, a "basal" method is usually employed instead—a single slow-acting dose, twice daily, along with a very low carbohydrate diet, attempts to keep the blood sugar within a recommended range for the entire day. In this case it's important for the pet to avoid large meals, since they can seriously affect the blood sugar. (Meals may also be timed to coincide with peak insulin activity.) Once-daily doses are not recommended for most cats[19], since insulin usually metabolizes faster in cats than in dogs[20] or humans; an insulin brand that lasts 24 hours in people may only be effective for about 12 in a cat[21].

For dogs, basal insulin only is the most common method of treatment[22]; most dogs don't require basal/bolus insulin injections[23].

Cats and dogs may be treated with animal insulins (pork-based is most similar to a dog's natural insulin, beef-based for a cat), or with human synthetic insulins. The best choice of insulin brand and type varies between pets and may require some experimentation. One of the popular human synthetic insulins, Humulin N /Novolin N/ NPH, is reasonable for dogs, but is usually a poor choice for cats[21], since cats' metabolize (most) insulin about twice as fast. The Lente and Ultralente versions were therefore very popular for feline use until summer 2005, when Eli Lilly and Novo Nordisk both discontinued them.

Until the early 1990s, the most recommended type for pets was beef/pork-derived PZI, but that type was phased out over the 1990s and is now difficult to find in many countries. There are sources in the US and UK, and many vets are now starting to recommend them again for pets, but they have been discontinued by most manufacturers as of 2007-2008.

Caninsulin ,known in the USA as Vetsulin, made by Intervet is a brand of pork-based insulin, which is approved for dogs and cats, and is available both through veterinarians and pharmacies with a veterinarian's prescription, depending on the country. Caninsulin can also be used for the ex-label treatment of diabetes mellitus in pet rabbits and guinea pigs. According to the manufacturer's website, Caninsulin's action profile is long and flat in dogs, but in cats very similar to that of NPH insulins, and lowers blood sugar quickly, but for only about 6–8 hours.

Two new ultra-slow time-release synthetic human insulins are just becoming available in 2004 and 2005 for improving basal stability, generically known as Insulin Detemir ("Levemir") and Insulin Glargine ("Lantus"). A mini-study at the University of Brisbane, Australia has had remarkable results with Insulin Glargine in cats. Followup research Roomp and Rand, Vet Intern Med 2008, 22 (3):791 shows that Levemir can be used with a similar protocol and that either insulin, on this protocol, leads in most uncomplicated feline cases to remission. With Lantus being unreliable in dogs, the insulin is rarely used in canine diabetes[24][25].

Neuropathy

The weak legs syndrome found in many diabetic cats is a form of neuropathy, in particular caused by damage to the myelin sheath of the peripheral nerves caused by glucose toxicity and cell starvation. (There are other conditions that can cause weak legs too, consult your vet before assuming neuropathy.) Most common in cats, the back legs become weaker until the cat displays "Plantigrade stance", standing on its hocks instead of on its toes as usual. The cat may also have trouble walking and jumping, and may need to sit down after a few steps. Some recommend a specific form of vitamin B12 called methylcobalamin to heal the nerve damage. Neuropathy often heals on its own within 1 to 3 months once blood sugar is regulated, but anecdotal evidence[26][27][28] points to a faster recovery rate with methylcobalamin supplements.

Dogs can also suffer from neuropathy and display plantigrade stance[29].

Chronic hypoglycemia episodes can cause the peripheral form of neuropathy in either species[30].

Cataracts in dogs

Cataracts are a frequent occurrence in diabetic dogs. Hyperglycemia in dogs can cause both cataracts; cataracts can cause blindness in a few days or weeks. Blood glucose levels as low as 250 mg/dL (14.0 mmol/L) can cause cataracts in dogs.

Dosage and regulation

Cats may in some cases have their mealtimes strictly scheduled and planned to match with injection times, especially when on insulins with a pronounced peak action like Caninsulin or Humulin N. In other cases where the pet free-feeds and normally eats little bits all day or night, it may be best to remain on this schedule and try to use a very slow-acting insulin to keep a constant level of blood glucose. Consult your veterinarian. Note that some veterinarians still use the outdated recommendation of using Humulin "N" or NPH insulin for cats. This insulin is too fast-acting for most cats (though fine for dogs and humans)[19]. Cat metabolize insulin about twice as fast as humans[31], and the often-effective slower-acting Lente and Ultralente (Humulin L and Humulin U) insulins are being discontinued (as of 2005), so most cats are now using either the veterinary PZI insulins, or the new full-day analogs glargine (Lantus) and detemir (Levemir).

The goal at first is to "regulate" the pet's blood glucose[32], which may take a few weeks or even many months. This process is basically the same as in type-1 diabetic humans. The goal is to keep the blood glucose values in a comfortable range for the pet during the whole day, or most of it.

The recommended method is to Start Low - Go Slow:

  1. Have an initial blood curve taken over 24 hours at the vet and receive an initial dosage recommendation.
  2. The initial dosage will be very conservative (low) (usually between 0.5 and 2 units daily, split into 12-hour dosages) and may not affect the pet's symptoms noticeably at first. This is necessary because although high blood sugar can kill within weeks, low blood sugar can kill in minutes. Dosage must be increased gradually and carefully. The usual recommended method is to increase the dose by 1/2 to 1 unit every 7 to 14 days, followed by further glucose testing. An initial decrease may also be necessary -- it is fairly common for the initial recommendation to be a little bit too high, especially if it was estimated by weight. See Chronic Somogyi Rebound below. Buying an inexpensive blood glucose meter and testing for yourself just before each shot and at midpoint is essential—it will save many expensive trips to the vet, avoid dangerous overdoses, and give you a better handle on the pet's ongoing condition. Urine strips are not accurate enough for this.
  3. Your pet is "regulated" when its blood glucose remains within an acceptable range all day, every day. Acceptable varies somewhat between cats, dogs, and vets, but is roughly from 5 to 16.7 mmol/L (90 to 300 mg/dL in the USA) for cats, and between 5 and 14 (90 to 250) for dogs. (The range is wider for diabetic animals than non-diabetic, since shots cannot replicate the accuracy of a working pancreas.) It's important, though, that the glucose level be in the lower half of that range for as much of the day as possible. If you are not doing home glucose testing, some vets recommend that you stop increasing the dosage when the dog or cat is drinking normally, urinating normally, and eating normally, although organ damage may continue in some cases until glucose is below the "Renal Threshold" -- testing urine with keto/glucostix will show when this has been achieved.
  4. Obstacles to regulation:
  • Sometimes your pet will suddenly appear to need less insulin than before. If this happens (their blood sugar will go lower than usual one day), drop the dose immediately and call your vet. If testing just before an injection, and the reading is much lower than expected, it may be wisest to skip that dose and continue retesting every 2-3 hours. If the drop is dramatic and leads to a hypoglycemic episode (see below), the cat's sensativit to insulin may increase dramatically. You should consider dropping their dose after consulting your veterinarian, and raise it only by half to one unit per 5-7 days, as before.
  • Sometimes your pet's blood sugar will suddenly seem much higher than usual. This is often not a good time to increase their insulin dosage -- quite the opposite. It often indicates that a low blood sugar condition (or rapid sugar drop) was experienced a few hours before, and a Somogyi rebound is in progress. To be sure, drop the next dose by 15%-50% and take glucose readings every 4 to 8 hours until the glucose levels out. Then wait a few more days for the Somogyi hormones to decrease in the body, and then you can increase again by 0.5-unit steps every 5-7 days. If you experienced this rebound, chances are that your original dose was too high, so you should try to find an ideal dose at a lower point.
  • Chronic overdose masked by Somogyi: A dose that is fractionally too high can easily cause a Somogyi rebound, which can look like a need for more insulin. This condition can continue for days or weeks, and it's very hard on the cat's metabolism. See more on this topic in the Somogyi section below.
  • High-carb cat food: Many commercial foods (especially "Light" foods) are extremely high in cereals and therefore carbohydrates. The extra carbohydrates will keep the cat's blood sugar high, and if you're free-feeding may also make the blood sugar curve over the course of the day unpredictable. In general, canned foods are lower in carbohydrates than dry ones, and canned "kitten" foods lower still. Recent studies show that cats' diabetes can be better regulated and even sometimes cured with a low carbohydrate diet. If switching to a lower-carbohydrate food, do it gradually and lower the insulin dosage appropriately, with your vet's help. If your cat is on a special diet for pancreatitis, chronic renal failure, or any other condition, consult your vet for the appropriate diet for that condition plus diabetes.
  • This does not apply to dogs as most of the commercially available prescription diabetes foods are high in fiber,[33] in complex carbohydrates[34] and have proven therapeutic results[35]. Dogs are not free-fed, but placed on a regimen of food and insulin every 12 hours[36]. Since dogs have type 1 (insulin-dependent) diabetes mellitus, there is no possibility their permanently damaged pancreatic beta cells could "re-awaken" to engender a remission[37][38].
  • In cases of secondary or transient diabetes where the condition may be caused by use of steroid medications, the hormones of heat (spaying can resolve the diabetes) / pregnancy, or other medical conditions such as Cushing's disease, it may be possible to treat the primary medical problem and revert the animal to non-diabetic status[39]. Returning to non-diabetic status would depend on the amount of damage the pancreatic insulin-producing beta cells have sustained[40].
  • Wrong insulin: Different brands and types of insulin have idiosyncratic effects on different cats and dogs. If you've settled on a dose that seems to keep the pet's blood sugar within range at peak effectiveness, but the sugar readings remain dangerously high at shot times, the insulin may not be lasting long enough for your pet, or may not be the best choice. Switching to a slower-acting or a better-tolerated insulin for that pet, and lowering the dose initially to be safe, may be the next step.

Blood sugar guidelines

Absolute numbers vary between pets, and with meter calibrations. Glucometers made for humans are generally accurate using canine and feline blood except when reading lower ranges of blood glucose (<80 mg/dl--4.44 mmol/L). It is at this point where the size difference in human vs animal red blood cells can create inaccurate readings[41]. The numbers below are as shown on a typical home glucometer while hometesting blood glucose, not necessarily the more accurate numbers a vet would see (though many vets use meters similar to those used in hometesting). For general guidelines only, the levels to watch are approximately:

mmol/L mg/dL(US)
<2.2 <40 Readings below this level are usually considered hypoglycemic[42][43] when giving insulin, even if you see no symptoms of it. Treat immediately[44]
2.2-7.5 40-130 Non-diabetic range[45] (usually unsafe to aim for when on insulin, unless your control is very good). These numbers, when not giving insulin, are very good news.
3.38-6.88 61-124[46] This is an average non-diabetic cat's level[47][48], but leaves little margin of safety for a diabetic on insulin. Don't aim for this range, but don't panic if you see it, either. If the number is not falling, it's healthy.
3.44-6 62-108 Non-diabetic glucose values for dogs who don't have diabetes[49].
5 90 A commonly cited minimum safe value for the lowest blood sugar of the day
7.8 140 According to the American Association of Clinical Endocrinologists (AACE)[50], threshold above which organ and pancreatic damage may begin[51].
5.5-10
100-180
Commonly used target range for diabetics, for as much of the time as possible.
10 180 "Renal threshold" for dogs when excess glucose from the kidneys spills into the urine and
roughly when the dog begins to show diabetic symptoms. See hyperglycemia for long-term effects of high blood glucose.
<13.33-15 240[52]-270 "Feline Renal threshold for glucose", when excess glucose from the kidneys spills into the urine and roughly when the cat begins to show diabetic symptoms. See Hyperglycemia in the Pet Diabetes Wiki for long-term effects of high blood glucose on cats.
14 250 Approximate maximum safe value for the highest blood sugar of the day, in dogs, who are more sensitive to high blood sugar. Dogs can form cataractsat this level. Cats should try to stay below this too. Check for ketones[53].
16.7 300 Approximate maximum safe value for the highest blood sugar of the day, in cats, to avoid neuropathy and complications. Some cats can go on long-term at this level or higher, but there will be side effects eventually[2]. Check for ketones.
>20 >360 Check for ketones[54][55] frequently, be sure you are giving insulin. Cats are much more resilient than dogs or humans at these high levels; nevertheless, the blood sugar should be lowered. The cat or dog can feel any of numerous ill effects both short and long-term, see hyperglycemia[56][57] for details.

Detecting and avoiding chronic Somogyi rebound

Oddly, too much insulin may result in increase of blood glucose (BG). This "Somogyi effect" is often noted by pet owners who monitor their pets' blood glucose at home.

The reason: anytime the glucose level drops too far or too fast, the animal's organism may defensively dump glucose (converted from glycogen in the liver), as well as hormones epinephrine and cortisol, into the bloodstream. (If these are insufficient, hypoglycemia ensues!) The glycogen raises the blood glucose, the other two may make the pet insulin-resistant for a time. This phenomenon was first documented by a Dr. Michael Somogyi.[58] [59].

Even when raising the insulin dose slowly and carefully, it's possible to pass the correct dose and go on to an overdose. (A typical case is increasing bidaily dosage from 1 unit to 2, passing a correct dose of 1.5 units.) This may produce a rebound—a swift jump in blood glucose up from a dangerously low reading, to beyond the previous pre-shot level. The pet may be a bit less responsive to the same dose the next shot, from those other hormones. Repeating the overdose on subsequent days, and checking only pre-shot readings or urine glucose, can give the dangerously wrong impression that more insulin is needed! Remember to check occasionally at the expected nadir (low point) as well.

It's unusual to be monitoring glucose right when this happens, and typical to just continue the overdose, leading to a repeated rebound situation. So it's good to learn to recognize the patterns of repeated rebound.

  • A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin!)
  • When using shorter-acting insulins, repeated Somogyi rebound may manifest instead as rapidly alternating high and low blood sugar numbers with no apparent logic. The highs and lows will both be exaggerated compared to what you'd see on a smaller dose.

It's not always easy to tell a rebound from a regular curve showing insulin action ending normally. One way to tell the difference is to take a "curve" (repeated tests every 2 hours starting with the insulin shot) on a weekend and look for the shape of the curve. If the curve is valley-shaped, and gradual, then you are not seeing Somogyi rebound. Other shapes should arouse suspicion. In particular, if the rise after peak action is faster and rises higher than the original pre-insulin level and the original fall in blood sugar, you have good cause to consider rebound. The only sure way to check is to reduce dosage and look for a better-shaped curve.

A fairly sure sign: Anytime blood glucose numbers seem higher after dosage is raised, consider the possibility of a somogyi rebound. But other things can cause unexpectedly high blood glucose too, so look for a clear correlation with dosage changes.

Always consult your veterinarian when changing your pet's insulin.

Hypoglycemic episode

An acute hypoglycemic episode (very low blood sugar) can happen even if you are careful, since pets' insulin requirements sometimes change without warning. The symptoms are depression/lethargy, confusion/dizziness, loss of excretory/bladder control, vomiting, and then loss of consciousness and/or seizures. As soon as possible, administer honey or corn syrup by rubbing it on the gums (even if unconscious, but not if in seizures), and rush it to the vet. Carry more honey or corn syrup with you on the way and keep rubbing it on the gums, where it can be absorbed—it could save the pet's life. Every minute without blood sugar causes brain damage. (Some recommend administering syrup anally if the animal is in seizures!)

If the pet has hypoglycemia according to the blood glucose meter (<2.2 mmol/L or 40 mg/dL), but no symptoms, give treats or food if possible. If they won't eat, try putting food in their mouth. If that doesn't work, administer some honey followed by food or cat treats, and continue to do so until the blood glucose is rising, and the latest insulin shot's peak action is past.

Sometimes a mild hypoglycemic episode will go unnoticed, or leave evidence such as an "accident" where kitty fails to make it to the litterbox. In these cases the blood sugar will probably appear paradoxically high upon the next test hours later, since the pet's body will react to the low blood sugar by stimulating the liver to release stored glycogen. This condition is known as Somogyi rebound (see link above), and requires a lowered insulin dosage for the next few days. The Somogyi rebound may also occur when the pet's blood glucose drops too rapidly, even if it never actually reaches a low reading.

Remission in cats

It is in many cases possible to induce remission (a temporary or permanent freedom from insulin-dependence) in type-2 diabetic cats. This appears to be unique to cats. There is growing agreement among experts[13][48] that a combination of low carbohydrate healthy diet, well-chosen insulin, and well-chosen dosage plans can in many cases partially heal a damaged pancreas and allow the cat's blood sugar to be controlled entirely by diet thereafter. (A low carbohydrate diet is usually required for the remainder of the cat's life.)

Remission is a realistic goal for treatment of type-2 diabetic cats (that is, 80-95% of all diabetic cats) who are properly regulated quickly[60]. Chances of success are highest in the first few months after initial diagnosis, due to ongoing damage from glucose toxicity caused by hyperglycemia. This limited time window is a good reason to start with low carbohydrate diet and very slow-acting insulins, the most successful known combination, right away.

An explanation can be pieced together from recent studies [61] in which diabetes in cats is perpetuated, if not always caused, by a combination of glucose toxicity[61] and amyloidosis, such that the insulin-producing islets of the pancreas become clogged with amyloid deposits. Cats may present with type-2 (insulin-resistant) diabetes, at least at first, but hyperglycemia and amyloidosis, left untreated, will damage the pancreas over time and progress to insulin-dependent diabetes[62].

If blood sugar is well-controlled over a period of 2-3 months, glucose toxicity and amyloidosis cease to attack newly generated tissue, and many cats are able to regenerate some of the damaged pancreatic beta cells and slowly resume insulin production.

Note that Glipizide and similar oral diabetic medicines designed for type-2 diabetic humans have been shown to increase amyloid production and amyloidosis, and therefore likely reduce likelihood of remission.[18]

References

  1. ^ Fat Cats Facing Diabetes Epidemic, The Guardian, August 7, 2007
  2. ^ McCann TM, Simpson KE, Shaw DJ, Butt JA, Gunn-Moore DA (August 2007). "Feline diabetes mellitus in the UK: the prevalence within an insured cat population and a questionnaire-based putative risk factor analysis". J. Feline Med. Surg. 9 (4): 289–99. doi:10.1016/j.jfms.2007.02.001. PMID 17392005. http://linkinghub.elsevier.com/retrieve/pii/S1098-612X(07)00028-9. 
  3. ^ Feline Diabetes is Nutrition Key, Vet Tech Blog, Feb 2006
  4. ^ Canine and Feline Diabetes Mellitus: Nature or Nurture?, J. Rand et al.
  5. ^ Understanding Feline Diabetes Mellitus, Rand, J.S. and Marshall, R, Waltham Focus Journal 2005, 15:3
  6. ^ Neuropathy-Canine Diabetes Wiki
  7. ^ Vetsulin-page 3
  8. ^ Juvenile Onset Diabetes Mellitus (Sugar Diabetes) in Dogs & Puppies-Drs. Foster & Smith-Pet Education
  9. ^ Insulin Glargine and a high protein-low carbohydrate diet are associated with high remission rates in newly diagnosed diabetic cats.
  10. ^ Feline Diabetes, Remission, and Various Insulins
  11. ^ Feline Diabetes: Pathogenesis and Treatment. Rand, Marshall 2006
  12. ^ Achieving Optimal control in diabetic dogs. Fleeman, Rand 2005
  13. ^ a b Study Shows 'Catkins' Diet Helps Cats Beat Diabetes
  14. ^ Frank GR, Anderson W, Pazak H, Hodgkins E, Ballam J, Laflamme D (2001). "Use of a High Protein Diet in the Management of Feline Diabetes Mellitus". Veterinary Therapeutics 2 (3): 238–46. PMID 19746667. 
  15. ^ Bennett N, Greco DS, Peterson ME, Kirk C, Mathes M, Fettman MJ (April 2006). "Comparison of a low carbohydrate-low fiber diet and a moderate carbohydrate-high fiber diet in the management of feline diabetes mellitus". J. Feline Med. Surg. 8 (2): 73–84. doi:10.1016/j.jfms.2005.08.004. PMID 16275041. http://linkinghub.elsevier.com/retrieve/pii/S1098-612X(05)00125-7. 
  16. ^ Achieving optimal control in Diabetic dogs. Fleeman, Rand. 2005
  17. ^ Veterinary Partner-Insulin Alternatives
  18. ^ a b Hoenig M, Hall G, Ferguson D, et al. (1 December 2000). "A feline model of experimentally induced islet amyloidosis". Am. J. Pathol. 157 (6): 2143–50. PMID 11106586. PMC 1885761. http://ajp.amjpathol.org/cgi/pmidlookup?view=long&pmid=11106586. 
  19. ^ a b Wallace MS, Peterson ME, Nichols CE (October 1990). "Absorption kinetics of regular, isophane, and protamine zinc insulin in normal cats". Domest. Anim. Endocrinol. 7 (4): 509–15. doi:10.1016/0739-7240(90)90008-N. PMID 2261761. 
  20. ^ Goeders LA, Esposito LA, Peterson ME (January 1987). "Absorption kinetics of regular and isophane (NPH) insulin in the normal dog". Domest. Anim. Endocrinol. 4 (1): 43–50. doi:10.1016/0739-7240(87)90037-3. PMID 3333933. http://linkinghub.elsevier.com/retrieve/pii/0739-7240(87)90037-3. 
  21. ^ a b Moise NS, Reimers TJ (January 1983). "Insulin therapy in cats with diabetes mellitus". J. Am. Vet. Med. Assoc. 182 (2): 158–64. PMID 6298164. 
  22. ^ WSAVA 2001-Diabetes Mellitus: Treatment Options-Insulin Therapy
  23. ^ What Can Be Done?-Treating the Complicated Diabetic Patient-David Church-WSAVA 2001
  24. ^ Comparison of The Pharmacodynamics and Pharmacokinetics of Subcutaneous Glargine, Protamine Zinc, and Lente Insulin Preparations In Healthy Dogs-VJ Stenner, LM Fleeman, and JS Rand. Centre for Companion Animal Health, School of Veterinary Science, The University of Queensland, Brisbane, Australia
  25. ^ OSU/Royal Canin Endocrine Symposium-Selecting an Insulin for Treating Diabetes Mellitus in Dogs and Cats-Nelson-page 40
  26. ^ Delano Report on Methyl-B12 and Neuropathy
  27. ^ Laurie Ulrich's story on Methylcobalamin and Neuropathy
  28. ^ Testimonials on Feline Diabetes message board re: Methylcobalamin and Neuropathy
  29. ^ Canine Diabetes Wiki-Neuropathy
  30. ^ Logical Approach to Weakness and Seizures-David B. Church-WSAVA 2009
  31. ^ Intervet Caninsulin overview, mentions cats faster metabolism of insulin, see page 4
  32. ^ What Is Regulation? k9diabetes.com
  33. ^ Fiber-Canine Diabetes Wiki
  34. ^ Carbohydrates-Canine Diabetes Wiki
  35. ^ Diabetes Mellitus-CVC Proceedings 2009-Foods and feeding the diabetic dog
  36. ^ WSAVA 2001-Diabetes Mellitus: Treatment Options-Insulin Therapy
  37. ^ Vetsulin FAQ's
  38. ^ BD Diabetes-Ask Dr. Greco
  39. ^ Providing Care for Veterinary Diabetic Patients-Canine Diabetes-International Journal of Pharmceutical Compounding
  40. ^ Canine Diabetes Mellitus-Routine Stabilization of Diabetes Mellitus in the Dog-WSAVA-2009
  41. ^ Diabetes Mellitus-Glucometers-Dr. William A. Schall-ACVIM-DVM 360 2009
  42. ^ hypoglycemia Pet Diabetes wiki
  43. ^ Hypoglycemia-Canine Diabetes wiki
  44. ^ Treating Hypoglycemia-Gorbzilla.com
  45. ^ VIN: Determination of Rate Natural Blood Glucose in Persian Cats, say "50-160mg/dl"
  46. ^ Merck Veterinary Manual
  47. ^ Feline Diabetes message board survey on non-diabetic cats' bg levels
  48. ^ a b Dr. E. Hodgkins, 2004, says "around 60mg/dl (3.4 mmol/L)"
  49. ^ Serum Biochemical References Ranges-Merck Veterinary Manual
  50. ^ AACE-Call For Better Glucose Management-Hospitalized Patients
  51. ^ organ damage threshold studies
  52. ^ Merck Veterinary Manual
  53. ^ Ketones-Canine diabetes wiki
  54. ^ Pet diabetes wiki-ketones
  55. ^ Ketones-Canine Diabetes wiki
  56. ^ Hyperglycemia Pet Diabetes Wiki
  57. ^ Hyperglycemia-Canine Diabetes wiki
  58. ^ [1]
  59. ^ Somogyi Phenomenon at eMedicine
  60. ^ Understanding Feline Diabetes Mellitus, Dr. J. Rand, University of Queensland
  61. ^ a b Robertson RP (October 2004). "Chronic oxidative stress as a central mechanism for glucose toxicity in pancreatic islet beta cells in diabetes". J. Biol. Chem. 279 (41): 42351–4. doi:10.1074/jbc.R400019200. PMID 15258147. http://www.jbc.org/cgi/content/full/279/41/42351. 
  62. ^ Islet Amyloid and Progression of Type-II Diabetes, Hayden, JOP

Further reading

General information

Specific topics

Inducing remission in cats


Advertisements






Got something to say? Make a comment.
Your name
Your email address
Message