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Successful management of diabetes in veterinary patients requires patience, data, and an individualized approach.
Diabetes occurs in dogs and cats and can be a frustrating disease to manage. During a recent Fetch dvm360® virtual conference, Heather Kvitko-White, DVM, DACVIM, founder of KW Veterinary Consulting and The Pragmatic Professor, discussed key points veterinarians and pet owners should know about diabetes to make disease management as smooth as possible.
Making the diagnosis
For canine patients, the presence of hyperglycemia and glucosuria is usually sufficient to diagnose diabetes. To avoid a delayed diagnosis when sending samples to an external laboratory for analysis, Kvitko-White recommends that an in-house blood glucose level be performed on all patients presenting with polyuria/polydipsia.
Diagnosing diabetes in cats is a bit more challenging. Kvitko-White notes that even blood glucose levels in the 400-mg/dL range might occur from transient stress hyperglycemia, making hyperglycemia and glucosuria alone unreliable for making the diagnosis. Even the presence of ketonuria does not confirm the diagnosis. In cats, a fructosamine level is the most reliable way to confirm the diagnosis.
Choosing an insulin
Insulin therapy is the cornerstone of diabetes management in veterinary patients, so choosing the best insulin for each patient is crucial. Veterinarians should consider the insulin’s duration of action (short-, intermediate-, or long-acting), patient size and species, the owner’s ability to administer insulin and monitor the patient, and anticipated costs to the owner. Initial dosing should be based on the patient’s lean body weight and insulin type.
Kvitko-White discussed her personal preferences for insulin in patients of various sizes and species:
- Small- to medium-sized dogs: Lente insulin (Vetsulin; Merck Animal Health) is an intermediate-acting insulin approved for use in dogs and cats. Vials should be replaced every 42 days.
- Larger dogs: Insulin detemir (Levemir; Novo Nordisk) is a highly potent, long-acting insulin. This allows smaller doses for large patients, contributing to cost savings over time.
- Cats: Insulin glargine (Lantus; sanofi-aventis). Kvitko-White noted that published recommendations often list Vetsulin or ProZinc (Boehringer-Ingelheim) as the preferred insulin types because they are FDA-approved, not because they have superior control in cats.
The cost of insulin, especially the long-acting insulins such as detemir and glargine, can be alarming for some pet owners. Kvitko-White said that because vials of these insulins can be used for 6 months, owners of large dogs and cats will save money over time despite the higher up-front cost. For large dogs, shorter-acting insulins require higher doses, requiring frequent replacements, sometimes more than monthly. For cats, shorter-acting insulins are less effective and need to be replaced more frequently because of their shelf-life.